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.

A comparative study of efficacy of salbutamol via metered dose inhaler with volumatic spacer and via dry powder inhaler, easyhaler, to nebulization in mild to moderate severity acute asthma exacerbation in childhood.

BACKGROUND: Rapid-acting inhaled beta-2 agonist is standard treatment in acute asthmatic patient; it causes smooth muscle dilatation, gives rapid action and has less side effect compared with parenteral and oral form. There are many forms of inhaler including nebulization, MDI and DPI. In Thailand the most common form of salbutamol administration for the treatment of acute exacerbation of asthma is via nebulization. OBJECTIVE: To compare the clinical effectiveness and side effects of salbutamol via MDI with Volumatic spacer and via DPI (Easyhaler), with nebulization in mild to moderate severity of acute asthma exacerbation in childhood. MATERIAL AND METHOD: A prospective, randomized controlled study in children, aged 5- 18-years-old with mild to moderate severe asthmatic attack, is done at the Emergency Room, QSNICH during October 2004 to February 2006. These children with acute asthma attack are randomly-assigned to 3 groups of different salbutamol administrations: group 1 via nebulization, group 2 via MDI with volumatic spacer and group 3 via DPI (Easyhaler). Salbutamol is administered and clinical responses: asthma score, oxygen saturation, PR, RR, BP and side effects (tremor and palpitation) are recorded at 0, 20, 40 and 60 minutes after the drug administrations. The drug will be repeated every 20 minutes for the total maximum of 3 times. If there is no clinical improvement, they will be admitted to the hospital for further management. RESULTS: There are 54 asthmatic children, 35 male (64.8%) and 19 female (35.2%). Their mean age is 8.4 +/- 2.3 years. There are 18patients in each group. There is no significant difference in efficacy of salbutamol among the 3 groups as measured by asthma score, O2 saturation, PR, RR and BP Tremor are equally observed in all 3 groups (5.5%) while palpitation are observed in 11.1% of group 1 and 2 only. One patient in group 2 and 3 are admitted while no patient in group 1 is. CONCLUSION: Rapid-acting inhaled beta-2 agonist via MDI with volumatic spacer and DPI (Easyhaler) can be used effectively compared with nebulization form in treating mild to moderate degrees of acute exacerbation of asthma in children with comparable side effects.

Childhood asthma: proper managements do reduce severity.

RATIONALE: Asthma is an increasing problem, both in children and adults which is due to an increase in environmental pollution. The current management of asthmatic patients is different from the previous decade as more understanding of the mechanism of asthma pathology is known. OBJECTIVES: To study the prevalence of hospitalized asthmatic patients of different age groups in the past decade and to compare the results of different treatments during each 5-year period, 1986-1990, 1991-1995 and 1997-2001. MATERIAL AND METHOD: A retrospective review of the Out-patient Department (OPD) and In-patient Department (IPD) cases of asthma patients, sorted by International Classification of Diseases (ICD 9 & 10) at the Queen Sirikit National Institute of Child Health (QSNICH), previously known as Children's Hospital was carried out. The patients were divided into 3 groups according to the 5-year period of admissions: 1986-1990, 1991-1995 and 1997-2001. Comparison of the prevalence, age distribution, management, severity and outcomes of the patients in different groups using the standard statistical package SPSS for windows. RESULTS: The prevalence of asthma increased from 7,476 OPD visits in 1986 to the peak of 15,576 visits in 1997 and about 13,000-14,000 stable visits from 1998 through 2001. About 2-3 per cent of these OPD cases were admitted to the hospital. After the hospital charts had been reviewed, 2,927 cases of true asthma cases (81.9%) were studied and they were divided into 3 groups, group 1, 2 and 3 consisting of 1,140, 716 and 1,071 patients, respectively. About 60-80 per cent of the admitted cases were children under 5 years old. With the different management of hospitalized cases between the 3 periods, a significant reduction in the readmission rate was outstanding from 14 per cent to 5 per cent and the maximum number of readmissions was reduced from 8 times to 5 times (the majority was 2 times). The length of stay and the percentage of complicated respiratory failure cases were not different. CONCLUSION: The asthma prevalence is increasing. Young children 0-2 years of age tend to have more severe diseases that need hospitalization. Current management, inhaled beta 2 agonists, together with anti-inflammatory drugs do reduce asthma severity to a certain degree. Early intervention of controller medications and regular follow-up care do reduce the readmissions. Further newer treatment of asthma is required for better outcomes of these asthmatic patients.