The Science Journal of the American Association for Respiratory Care

1995 OPEN FORUM Abstracts

ALBUTEROL ADMINISTERED BY METERED DOSE INHALER WITH HOLDING CHAMBER IS MORE EFFECTIVE THAN JET NEBULIZATION IN TREATING ACUTE ASTHMA IN CHILDREN

Billy M. Lamb BS, RRT, CPFT, Albert Nakanishi MD, Edmond Smith MA, RRT, RPFT, Bruce K Rubin, MD, FCCP, Saint Louis University Department of Pediatrics and Cardinal Glennon Children's Hospital, St. Louis, MO.

INTRODUCTION: Studies of acute asthma in adults suggest that the dose of albuterol needed for optimal bronchodilitation is 2-12 times greater if medication is given by jet nebulizer (JN) than by metered dose inhaler with holding chamber (MDI-HC). The use of MDI-HC rather than JN results in a cost savings for the respiratory care services. As there are few pediatric data comparing MDI-HC therapy with JN we conducted a randomized, placebo controlled study in 30 children (age 6-12 years) who required therapy for acute asthma. We hypothesized that MDI-HC is as effective as JN for administering albuterol to children for acute asthma.

Methods: After measuring pulmonary function (PFT) and obtaining informed consent, children were randomized into one of two treatment groups; albuterol (30 mcg/kg- up to 1.5 mg) administered by MDI-HC using an Aerochamber (Monaghan Medical) followed by placebo JN with normal saline or albuterol administered by JN (0.15 mg/kg- up to 5 mg) followed by MDI-HC, 1 puff (actuation) per 5 kg (maximum 15 puffs). Ten minutes after each treatment, the child completed a side-effects questionnaire and repeated PFT. Each child had two sets of assigned therapy. PFT were performed using a PC based MultiSPIRO-SX^{TM} (MultiSPIRO, Inc. Irvine, CA).

Results: Patients treated with MDI-HC were less tried and had greater tremor when compared to those treated with JN (X² p < 0.05). Linear regression on log albuterol dose over the maximal response range of a 40-60% improvement in FEV_1 suggested that 12 times more medication was required using JN to achieve a 40% improvement in FEV_1 and 4 times more was needed to achieve a 60% increase with a mean of 7.7 times more by JN over this range. More than 75% of the bronchodilation was obtained after the first active treatment with either JN or MDI-HC. There was a significant placebo effect associated with the use of saline by JN in that children reported that they could breathe more easily despite the lack of change in PFT. No such effect was noted with the use of placebo MDI-HC. Our cost for delivery of albuterol by JN therapy are $8.56 for set up and $5.68 per treatment (includes RCP time, meds. and all supplies); cost for albuterol therapy with MDI-HC are $18.32 set up and $2.13 per treatment (includes RCP time, meds. based upon 6 puffs/treatment and holding chamber). Based upon a model of the patient receiving set up and two treatments in the emergency room, then Q4 hour therapy, MDI-HC results in a $18.64 savings after the first 24 hours and $21.38 per day thereafter. At the #3 treatment interval, MDI-HC cost were $24.71 and JN cost were $25.60. CONCLUSION: These data support the use of albuterol given by MDI-HC in the treatment of acute asthma in children. When three or more treatments are required, MDI-HC therapy is more cost effective than JN for treatment of acute asthma in children.

Supported by Monaghan Medical Corporation.

OF-95-076

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