title: Implementation of a Policy Change: Replacement of Nebulizers by Spacers for the Treatment of Asthma in Children.
abstract: BACKGROUND
  Treatment using inhaled bronchodilators for asthma with a metered dose inhaler attached to a spacer device (MDI+S) was shown to be as efficient as nebulizers. Nevertheless, nebulizers remain the treatment of choice in most hospitals.
  
  
  OBJECTIVE
  To implement a policy change to improve asthma treatment in pediatric wards and the pediatric emergency department.
  
  
  METHODS
  The study was performed in the emergency department and pediatric wards of a university medical center. The study group comprised all children admitted with a diagnosis of asthma necessitating treatment. The medical and nursing staff of both the pediatric emergency department and the pediatric wards was trained how to use metered dose inhalers attached to spacers on a regular basis in asthmatic pediatric patients. At a preset date nebulizers were replaced by spacers and their use was monitored by the supervising physician. Salbutamol was administered by a metered dose inhaler (100 μg/puff) attached to a spacer device. The number of puffs was determined by severity of disease according to GINA recommendations. After 2 years the outcome and cost analysis were examined.
  
  
  RESULTS
  During 3 years since the initial policy change 92.5%, patients were treated with spacers throughout their hospital stay (emergency department and pediatric ward). Costs were reduced by an estimated 63%.
  
  
  CONCLUSIONS
  In view of its many advantages, replacing nebulizers by MDI+S for the treatment of acute asthma.is, feasible, if performed in collaboration with the staff, hospital authority and patients.
authors.forename: Oded
authors.initials: O
authors.lastname: Breuer
authors.forename: David
authors.initials: D
authors.lastname: Shoseyov
authors.forename: Eitan
authors.initials: E
authors.lastname: Kerem
authors.forename: Rebecca
authors.initials: R
authors.lastname: Brooks
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D036503:Inhalation Spacers; D008297:Male; D036501:Metered Dose Inhalers; D009330:Nebulizers and Vaporizers; D016134:Organizational Policy
chemical_list: D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D000420:Albuterol