title: Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department.
abstract: OBJECTIVE
  To determine if administration of albuterol by a metered-dose inhaler with a spacer device is as efficacious as administration of albuterol by nebulizer to treat wheezing in children aged 2 years and younger.
  
  
  METHODS
  Double-blind, randomized, placebo-controlled clinical trial.
  
  
  METHODS
  Pediatric emergency department.
  
  
  METHODS
  From a convenience sample of wheezing children aged 2 to 24 months, 85 patients were enrolled in the nebulizer group and 83 in the spacer group.
  
  
  METHODS
  The nebulizer group received a placebo metered-dose inhaler with a spacer followed by nebulized albuterol. The spacer group received albuterol by a metered-dose inhaler with a spacer followed by nebulized isotonic sodium chloride solution. Treatments were given every 20 minutes by a single investigator blinded to group assignment.
  
  
  METHODS
  The primary outcome was admission rate. Pulmonary Index score and oxygen saturation were measured initially and 10 minutes after each treatment.
  
  
  RESULTS
  The nebulizer group had a significantly higher mean (SD) initial Pulmonary Index score compared with the spacer group (7.6 [2.5] vs 6.6 [2.0]; P =.002). With the initial Pulmonary Index score controlled, children in the spacer group were admitted less (5% vs 20%; P =.05). Analyses also revealed an interaction between group and initial Pulmonary Index score; lower admission rates in the spacer group were found primarily in children having a more severe asthma exacerbation.
  
  
  CONCLUSIONS
  Our data suggest that metered-dose inhalers with spacers may be as efficacious as nebulizers for the emergency department treatment of wheezing in children aged 2 years or younger.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Jacobi Medical Center, 1400 Pelham Pkwy S, Room 1W20, Bronx, NY 10461, USA.
authors.forename: Annette
authors.initials: A
authors.lastname: Delgado
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Chou
authors.forename: Ellen Johnson
authors.initials: EJ
authors.lastname: Silver
authors.forename: Ellen F
authors.initials: EF
authors.lastname: Crain
mesh_terms: D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002675:Child, Preschool; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D036501:Metered Dose Inhalers; D009330:Nebulizers and Vaporizers; D009519:New York City; D012119:Respiration / Q000187:drug effects; D012135:Respiratory Sounds / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol