title: Efficacy of metered-dose inhalers for children with acute asthma exacerbations.
abstract: OBJECTIVE
  To compare the effectiveness of the administration of inhaled beta-agonists delivered via a metered-dose inhaler (MDI) with spacers--as part of an evidence-based asthma pathway developed to manage acute asthma exacerbations in children at the emergency room level and in inpatient management--against administration via nebulization.
  
  
  METHODS
  Case with historical control.
  
  
  METHODS
  KK Women's and Children's Hospital (Singapore).
  
  
  METHODS
  A total of 19,951 children (infants to older children) aged 18 years and younger who attended the emergency room for asthma exacerbations.
  
  
  METHODS
  Average length of stay, proportion admitted to high dependency or intensive care, proportion readmitted for unresolved symptoms within 72 hr, cost per patient and overall.
  
  
  RESULTS
  There was no increase in the mean proportion of emergency room attendances admitted to inpatient care with use of an MDI (mean difference 0.97%, 95% CI: -1.6-3.5%, P = 0.447), nor of children admitted to intensive care (0.21 vs. 0.20 pre- and post-pathway, P = 0.827) or to high dependency units (2.21 vs. 1.37 pre- and post-pathway, P = 0.200) but a significant reduction in the within 72 hr re-attendance rate (mean difference 1.4%, 95% CI: 0.78-2.0%, P < 0.001) with use of an MDI. The average length and cost per patient for an inpatient stay for acute asthma exacerbations was reduced with use of an MDI.
  
  
  CONCLUSIONS
  The use of an MDI with spacer as part of an evidence-based asthma pathway was effective in the management of acute asthma exacerbations in the emergency room setting and for inpatient management.
authors.affiliation: KK Women's and Children's Hospital, Singapore, Singapore. anne.goh.en@kkh.com.sg.
authors.forename: Anne Eng Neo
authors.initials: AE
authors.lastname: Goh
authors.forename: Jenny Poh Lin
authors.initials: JP
authors.lastname: Tang
authors.forename: Ho
authors.initials: H
authors.lastname: Ling
authors.forename: Teoh Oon
authors.initials: TO
authors.lastname: Hoe
authors.forename: Ng Kee
authors.initials: NK
authors.lastname: Chong
authors.forename: Chay Oh
authors.initials: CO
authors.lastname: Moh
authors.forename: Chan Yiong
authors.initials: CY
authors.lastname: Huak
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D036501:Metered Dose Inhalers; D012846:Singapore; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000318:Adrenergic beta-Agonists