title: Spacers versus nebulizers in treatment of acute asthma - a prospective randomized study in preschool children.
abstract: OBJECTIVE
  To compare administration of bronchodilators by nebulizers with delivery by metered dose inhalers (MDIs) with spacers and to evaluate the clinical effect of the treatment of acute asthma in preschool children.
  
  
  METHODS
  A prospective randomized clinical trial in a pediatric emergency department (PED). Preschool children who were admitted for virus induced wheezing or acute asthma exacerbation were randomly allocated to receive bronchodilator treatment by nebulizer or by metered dose inhaler. The accompanying parents completed a questionnaire.
  
  
  RESULTS
  The length of stay in the PED and the hospitalization rate were similar and no difference was seen in the parents' view of ease of use and device acceptance. Baseline data were similar for both groups apart from the family history of asthma and atopic disease that was greater in the nebulizer group. No significant differences were seen in heart rate, respiratory rate and oxygen saturation at baseline and after the treatment. According to the parents 40% of the participants had asthma diagnosis though up to 66% had some kind of asthma medication.
  
  
  CONCLUSIONS
  Our data suggests that MDIs with spacers are at least as effective as nebulizers in the delivery of beta agonists to treat preschool children with virus induced wheezing or acute exacerbations of asthma in the PED. Parents may underestimate the gravity of their children's asthma. It is mandatory to provide adequate information to the staff and parents in order to treat pediatric acute asthma successfully.
authors.affiliation: a Department of Pediatrics , Örebro University Hospital , Örebro , Sweden.
authors.forename: Niki
authors.initials: N
authors.lastname: Mitselou
authors.affiliation: b Department of Women's and Children's Health and Centre for Allergy Research , Karolinska Institutet, Astrid Lindgren Children's Hospital , Stockholm , Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Hedlin
authors.affiliation: c Department of Pediatrics , Karlstad Central Hospital , Karlstad , Sweden.
authors.forename: Carl-Axel
authors.initials: CA
authors.lastname: Hederos
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009330:Nebulizers and Vaporizers; D010290:Parents; D012135:Respiratory Sounds / Q000187:drug effects; D011795:Surveys and Questionnaires
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents
keywords: Emergency department; bronchodilators; hospitalization rate; information; metered dose inhalers; pediatric; wheezing