ABSTRACT
INTRODUCTION: Spacer devices optimize delivery of aerosol therapies and maximize therapeutic efficacy. We assessed the impact of spacer device on the prevalence and magnitude of bronchodilator response (BDR) in children with asthma. METHODS: Children with physician confirmed asthma and parentally reported symptoms in the last 12 months were recruited for this study. Each participant completed two separate visits (5-10 days apart) with spirometry performed at baseline and following cumulative doses of salbutamol (200, 400, 800, and 200 µg) delivered by either a small volume disposable spacer or a large volume multi-use spacer. Spacer type was alternated for each participant during each visit. The primary outcome was the effect of spacer type on bronchodilator responsiveness. The secondary outcome was to assess the relationships between spacer device, salbutamol dose and the proportion of children with a clinically relevant BDR. RESULTS: Thirty-two children (mean age 11.8 years) completed both visits. Change in lung function following bronchodilators was increased using the large volume spacer, for relative but not absolute increase in FEV1 [mean difference (95% confidence intervals): 1.28% (0.02, 2.54; P = 0.047) and 0.013 L (-0.01, 0.04; P = 0.288)], respectively. There was no observed difference in FVC by spacer type. Overall, 59% (n = 19) of children exhibited a clinically relevant BDR at 400 µg of salbutamol for any spacer and was independent of spacer type. CONCLUSION: Spacer device was not associated with clinically important differences in lung function following bronchodilator inhalation in children with asthma. At a recommended dose of 400 µg, some children with asthma may have their bronchodilator responsiveness misclassified.
Subject(s)
Albuterol/administration & dosage , Asthma/drug therapy , Bronchodilator Agents/administration & dosage , Metered Dose Inhalers , Administration, Inhalation , Adolescent , Albuterol/therapeutic use , Asthma/physiopathology , Bronchodilator Agents/therapeutic use , Child , Cross-Over Studies , Female , Forced Expiratory Volume , Humans , Male , Nebulizers and Vaporizers , Respiratory Function Tests , SpirometryABSTRACT
BACKGROUND: Interactive games that highlight global health challenges and solutions are a potential tool for increasing interest in global health. To test this hypothesis, we developed an interactive "Polio Eradication" (PE) game and evaluated whether playing or watching was associated with increased public interest in global health. MATERIALS AND METHODS: The PE game is a life-size, human board game that simulates PE efforts. Four players-a researcher, a transportation expert, a local community coordinator, and a healthcare worker-collaborate as an interdisciplinary team to help limit ongoing and future polio outbreaks in Pakistan, represented on the game board. Participants who played or observed the game and those who did not participate in the game, but visited noninteractive global health exhibits, completed a survey on participation outcomes. We used relative risk regression to examine associations between cofactors and change in global health interest. RESULTS: Three variables predicted increased global health interest among the game participants: Having little or no previous global health knowledge prior to playing the game (risk ratio [RR]=1.28; 95 percent confidence interval [CI], 1.13-1.45), not currently being involved in global health (RR=1.41; 95 percent CI, 1.07-1.85), and visiting Seattle (RR=1.25; 95 percent CI, 1.04-1.51). CONCLUSIONS: Our results suggest that a hands-on, interactive game may increase the public's interest in global health, particularly among those with minimal previous knowledge of or involvement in global health activities.
