title: Metered dose inhaler with spacer versus dry powder inhaler for delivery of salbutamol in acute exacerbations of asthma: a randomized controlled trial.
abstract: BACKGROUND
  Delivery of various drugs by aerosol inhalation is the mainstay of treatment of asthma. Many delivery systems have been developed for children, each having its own advantages and disadvantages. Studies comparing the clinical efficacy of metered dose inhalers (MDI) and dry powder inhalers (DPI) in the treatment of acute exacerbations of asthma in children are limited. We conducted a study to compare the response to salbutamol inhalation delivered by metered dose inhaler with a spacer versus rotahaler (DPI) in children presenting with mild or moderate acute exacerbations of asthma.
  
  
  METHODS
  Children in the age group of 5-15 years who presented with a mild or moderate acute exacerbation of asthma were randomized to receive 400 micrograms salbutamol by either a MDI with spacer or a DPI. The changes in the wheezing and accessory muscle scores, SaO2, and PEFR were recorded and subjected to statistical tests for significance.
  
  
  RESULTS
  One hundred and fifty three children were studied; 78 were assigned to the MDI-spacer group and 75 to rotahaler (DPI) group. After receiving treatment, the PEFR improved by about 11% in both the groups. The oxygen saturation increased by 2% in both the groups. Within each group, the improvement in PEFR, SaO2, wheeze and accessory muscle score after the treatment was statistically significant. In both the groups the children co-operated equally well.
  
  
  CONCLUSIONS
  Metered dose inhaler with spacer and dry powder inhaler have equal efficacy in delivering salbutamol in therapy of mild to moderate acute exacerbations of bronchial asthma in children between 5-15 years of age.
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Lodha
authors.forename: Gaurav
authors.initials: G
authors.lastname: Gupta
authors.forename: Bedanta Prakash
authors.initials: BP
authors.lastname: Baruah
authors.forename: Rajiv
authors.initials: R
authors.lastname: Nagpal
authors.forename: S K
authors.initials: SK
authors.lastname: Kabra
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000293:Adolescent; D000336:Aerosols; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D010100:Oxygen / Q000097:blood; D010366:Peak Expiratory Flow Rate; D011208:Powders
chemical_list: D000336:Aerosols; D001993:Bronchodilator Agents; D011208:Powders; D000420:Albuterol; D010100:Oxygen