[Bronchodilators via metered-dose inhaler with spacer in the pediatric emergency department: what is the dosage?].
BACKGROUND
Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage.


OBJECTIVE
To assess the effectiveness of distinct salbutamol and terbutaline doses delivered via an MDI with spacer for the treatment of acute asthma in the pediatric emergency department.


METHODS
This was a prospective, double-blind randomized study. All consecutive children (n = 324) between 2 and 14 years of age with acute asthma exacerbations treated in the pediatric emergency department between October 1 and November 30, 2004, were included. Two treatment groups were established: one group received a number of puffs equivalent to half the child's weight (1 puff of salbutamol = 100 microg and 1 puff of terbutaline = 250 microg) and the other group received a number of puffs equivalent to one-third of the child's weight.


RESULTS
Three hundred twenty-four episodes were studied; there were 164 children in the first group and 160 in the second. There were no significant differences between the two groups in the mean (6 SD) age (58.34 +/- 34.72 vs 66.04 +/- 36.45 months), arterial oxygen saturation (95.49 +/- 1.93 vs 95.56 +/- 1.97) or pulmonary score (4.04 +/- 1.55 vs 3.97 +/- 1.51) at recruitment and after treatment in the emergency department (arterial oxygen saturation [96.34 +/- 1.60 vs 96.18 +/- 1.77], pulmonary score [1.87 +/- 1.33 vs 1.64 +/- 1.31]). The number of doses administered (2.17 +/- 0.91 vs 2.24 +/- 1.00) and the hospitalization rate (8.56 % vs 6.87 %) were also similar in both groups.


CONCLUSIONS
The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of high doses of bronchodilators, at least in most acute asthma exacerbations in children.
Benito Fernández
J
J
Servicio de Urgencias de Pediatría, Hospital de Cruces, Baracaldo, Bilbao, Spain. jbenito@hcru.osakidetza.net
Trebolazabala Quirante
N
N
Landa Garriz
M
M
Mintegi Raso
S
S
González Díaz
C
C
D000293:Adolescent; 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; D004636:Emergency Service, Hospital; D006801:Humans; D036503:Inhalation Spacers; D036501:Metered Dose Inhalers; D010372:Pediatrics; D011446:Prospective Studies; D013726:Terbutaline / Q000008:administration & dosage
D001993:Bronchodilator Agents; D013726:Terbutaline; D000420:Albuterol