Comparison of salbutamol efficacy in children- via the metered-dose inhaler (MDI) with Volumatic® spacer and via the dry powder inhaler, Easyhaler®, with the nebulizer - in mild to moderate asthma exacerbation: a multicenter, randomized study.

Background: β2 agonist administered via a nebulizer is the standard treatment for acute asthma exacerbation. There are some limitations for the use of nebulization. We conducted a study to determine the efficacy of salbutamol administered via the pMDI with Volumatic® spacer and the Easyhaler®(DPI) compared to nebulization in mild to moderate asthma exacerbations in children. Methods: A multicenter, randomized, controlled study was conducted in children between 5 and 18 years of age who presented at an emergency or outpatient department. They were randomized to receive either 6 puffs of salbutamol via the pMDI with Volumatic® spacer, or via the Easyhaler®, or 0.15 mg/kg of salbutamol nebulized via oxygen (or compressed air). The primary outcome was the clinical response which was assessed using the modified Wood’s asthma score. The secondary outcomes were: hospitalization, asthma re-visit within 3 days, systemic corticosteroid use and adverse events. The clinical score, oxygen saturation, PR, RR, BP and adverse events were recorded at time 0 (before treatment) and 20, 40 and 60 minutes after drug administration. Results: There were no statistically significant differences in the clinical response between the three groups at the 1st, 2nd or 3rd dose or for the SpO2 or the respiratory rate while the children in the Easyhaler® group had significantly less tachycardia after the 2nd dose. No significant adverse events were noted among the three groups. Conclusions: Salbutamol administered via pMDI with Volumatic® spacer or DPI (Easyhaler®) are as effective as salbutamol given via a nebulizer in providing effective relief of mild to moderate severity acute asthma exacerbation in children between 5 and 18 years of age.

Childhood asthma on South Thailand: A prospective study of 100 cases.

One hundred Thai asthmatic children aged below 15 years were under prospectice study. Fifty-seven percent of the patients were from Songkhla province and fourty three percent from nearby provinces in the south of Thailand. Males were more affected than females, male and female ratio being 3 : 2. Fifty-six percent of patients developed first attacks within the first 2 years of life. Attacks during night time were common and seasonal attacks usually occurred during the rainy season. Respiratory infections were the most common precipitants of attacks. Other precipitating factors were weather change, exertion, inhalants, emotion and irritants. Sixty-one percent of patients had associated allergic diseases and 81 percent had family history of allergic diseases. Sixteen percent of the patients were growth retarded. Absolute oeosinophil of less than 500 cells/mm3 was found in 36 percent of patients. Chest roentgenography at the first visit was found to be abnormal in 42 percent of patients. Ninety-three percent of the cases had positive skin tests. The important antigens were house dust and mite. Our findings are similar to previous studied with minor variations.