title: Treatment of acute asthma: salbutamol via jet nebuliser vs spacer and metered dose inhaler.
abstract: OBJECTIVE
  To compare the efficacy of salbutamol delivered by jet nebuliser (JN) with salbutamol via a pressurised metered dose inhaler (PMDI) and a large volume spacer (Volumatic) for management of acute asthma.
  
  
  METHODS
  A total of 160 children aged from 4 to 12 years presenting to an Emergency Department with acute asthma.
  
  
  METHODS
  The study was of multicentre (n=5) randomised, double blind, parallel design. Children weighing less than 25 kg received salbutamol 2.5 mg via the JN or 600 microg (six puffs) from the PMDI. Children over 25 kg received salbutamol 5 mg via the JN or 1200 microg (12 puffs) via the PMDI. Clinical score (range 0-12) and PEF (over 7 years) were recorded at baseline and 15, 30, 45 and 60 mins post administration.
  
  
  RESULTS
  The improvement from baseline at 30 min in the clinical score was 1.87 for JN and 1.43 for PMDI (P=0.09) and at 60 min was 2.15 for JN and 1.12 for PMDI (P=0.0001). The improvement in PEF at 30 min was 51 L min(-1) for JN and 27 L min(-1) for PMDI (P=0.0007) and at 60 min was 57 L min(-1) for JN and 31.5 L min(-1) for PMDI (P=0.001).
  
  
  CONCLUSIONS
  Administration of salbutamol via a PMDI and a large volume spacer device provides effective relief in the management of acute asthma in children, but to a lesser extent than a jet nebuliser. This difference may represent a dose response effect.
authors.affiliation: Department of Thoracic Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: C F
authors.initials: CF
authors.lastname: Robertson
authors.forename: M A
authors.initials: MA
authors.lastname: Norden
authors.forename: D A
authors.initials: DA
authors.lastname: Fitzgerald
authors.forename: F L
authors.initials: FL
authors.lastname: Connor
authors.forename: P P
authors.initials: PP
authors.lastname: Van Asperen
authors.forename: P J
authors.initials: PJ
authors.lastname: Cooper
authors.forename: P W
authors.initials: PW
authors.lastname: Francis
authors.forename: H D
authors.initials: HD
authors.lastname: Allen
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000336:Aerosols; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers
chemical_list: D000336:Aerosols; D001993:Bronchodilator Agents; D000420:Albuterol