title: Efficacy and cost comparisons of bronchodilatator administration between metered dose inhalers with disposable spacers and nebulizers for acute asthma treatment.
abstract: BACKGROUND
  Despite demonstration of equivalent efficacy of beta agonist delivery using a metered dose inhaler (MDI) with spacer vs. nebulizer in asthma patients, use of a nebulizer remains standard practice.
  
  
  OBJECTIVE
  We hypothesize that beta agonist delivery with a MDI/disposable spacer combination is an effective and low-cost alternative to nebulizer delivery for acute asthma in an inner-city population.
  
  
  METHODS
  This study was a prospective, randomized, double-blinded, placebo-controlled trial with 60 acute asthma adult patients in two inner-city emergency departments. Subjects (n = 60) received albuterol with either a MDI/spacer combination or nebulizer. The spacer group (n = 29) received albuterol by MDI/spacer followed by placebo nebulization. The nebulizer group (n = 29) received placebo by MDI/spacer followed by albuterol nebulization. Peak flows, symptom scores, and need for rescue bronchodilatator were monitored. Median values were compared with the Kolmogorov-Smirnov test.
  
  
  RESULTS
  Patients in the two randomized groups had similar baseline characteristics. The severity of asthma exacerbation, median peak flows, and symptom scores were not significantly different between the two groups. The median (interquartile range) improvement in peak flow was 120 (75-180) L/min vs. 120 (80-155) L/min in the spacer and nebulizer groups, respectively (p = 0.56). The median improvement in the symptom score was 7 (5-9) vs. 7 (4-9) in the spacer and nebulizer groups, respectively (p = 0.78). The median cost of treatment per patient was $10.11 ($10.03-$10.28) vs. $18.26 ($9.88-$22.45) in the spacer and nebulizer groups, respectively (p < 0.001).
  
  
  CONCLUSIONS
  There is no evidence of superiority of nebulizer to MDI/spacer beta agonist delivery for emergency management of acute asthma in the inner-city adult population. MDI/spacer may be a more economical alternative to nebulizer delivery.
authors.affiliation: North Central Bronx Hospital, Bronx, New York, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Dhuper
authors.forename: Alpana
authors.initials: A
authors.lastname: Chandra
authors.forename: Aziz
authors.initials: A
authors.lastname: Ahmed
authors.forename: Sabin
authors.initials: S
authors.lastname: Bista
authors.forename: Ajit
authors.initials: A
authors.lastname: Moghekar
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chong
authors.forename: Chang
authors.initials: C
authors.lastname: Shim
authors.forename: Hillel
authors.initials: H
authors.lastname: Cohen
authors.forename: Sonia
authors.initials: S
authors.lastname: Choksi
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004209:Disposable Equipment / Q000191:economics; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000191:economics / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D009330:Nebulizers and Vaporizers / Q000191:economics / Q000706:statistics & numerical data; D009519:New York City; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D011446:Prospective Studies; D012129:Respiratory Function Tests; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol