title: Pressurised metered dose inhalers with spacers versus nebulisers for beta-agonist delivery in acute asthma in children in the emergency department.
abstract: OBJECTIVE
  Wet nebulisers are widely used for beta-2 agonist delivery in Australasian emergency departments (ED). An increasing body of work suggests that pressurised metered dose inhalers with spacers (pMDI-S) are as effective. This study aims to investigate the effect on admission rates, total time in the ED, and total time in hospital after initiation of routine pMDI-S treatment for mild to moderate asthma in children presenting to the ED.
  
  
  METHODS
  Children with a discharge diagnosis of asthma were identified over sequential 3 month time periods. In the first period, wet nebuliser treatment was routine and in the subsequent trial period pMDI-S treatment was instituted as routine. Admissions rates, total time in hospital, and total time in the ED were recorded for each group.
  
  
  RESULTS
  Admission rates fell significantly from 31% to 20.6% after routine use of pMDI-S treatment. There was a non-significant trend to an increase in total ED and total hospital times.
  
  
  CONCLUSIONS
  Introduction of routine pMDI-S treatment in the paediatric ED results in a significant drop in admission rates but no significant change in total hospital times or total ED times.
authors.affiliation: Emergency Department, Lyell McEwin Health Services, Elizabeth Vale SA 5067, South Australia. Russell.Boyd@nwahs.sa.gov.au
authors.forename: R
authors.initials: R
authors.lastname: Boyd
authors.forename: P
authors.initials: P
authors.lastname: Stuart
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D036501:Metered Dose Inhalers; D009330:Nebulizers and Vaporizers
chemical_list: D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents