1996 OPEN FORUM Abstracts
ALBUTEROL GIVEN BY METERED DOSE INHALER WITH HOLDING CHAMBER AND MASK WITH EXHALATION VALVE IS EFFECTIVE FOR THE TREATMENT OF ASTHMA IN YOUNG CHILDREN.
Billy M Lamb, BS, RRT, CPFT, Bruce K Rubin. MD, FCCP, Albert Nakanishi, MD, Edmond Smith, MA, RRT, RPFT, David Geller, MD, Cardinal Glennon Children's Hospital, St. Louis, MO. and All Children's Hospital (DG), St. Petersburg, FL.
INTRODUCTION: Clinicians have been hesitant to use metered dose inhalers (MDI) for treatment of the young child based upon concerns for patient ability to cooperate and uncertainty about effectiveness of medication delivery. A holding chamber with mask (HCM: AeroChamber, Monaghan Medical Inc.) has recently been altered with a clear body to permit visual confirmation of medication delivery, mask deadspace volume was reduced an exhalation valve was built into the mask to improve patient comfort. The purpose of this study was to evaluate the HCM, the HCM with exhalation valve (HCMV) and jet nebulization (JN) for treating young children with asthma. Patient comfort, asthma symptoms, and patient compliance were measured. The HCMV was compared to the HCM and JN. Methods: Fifteen children ages 1-6 years (mean 3.3 years) seen in the emergency department (ED) were enrolled in this prospective unblinded trial. Entry into the study required an age of 1-6 years and a diagnosis of acute asthma, confirmed by a positive response to an initial JN treatment (TX) with albuterol (ALB) 2.5 mg in 2 cc normal saline (NS). Informed consent was obtained from the parent and patients were randomized into one of three groups to receive 2 weeks of therapy: group (1) ALB 2.5 mg in NS by JN, (2) ALB 450 mcg given by MDI with HCM, or (3) ALB 450 mcg administered by MDI and HCMV. Exclusion criteria: patients with chest disease other than asthma, patients regularly taking bronchodilators, or if hospital admission was required. Patients & parents were given a set of instructions and daily diary cards for recording medication administration and 4 point scales to record response to medication and asthma symptoms. The parent was asked to score how well the child tolerated each treatment (tolerated well. mild discomfort. cried. unwilling to take treatment). The mean scores for tolerability each day were compared using the Kruskal-Wallis test. Participants were instructed and required to demonstrate the use of the assigned device before discharge from the ED and upon their return visit. Study participants were scheduled for follow up in the Asthma Center in 2 weeks, on completion of the study. Results: One 14 month old child randomized to HCMV was excluded because TX plan was not followed. Initial asthma severity assessed by ED physician was similar in each group (p=0.80). There was similar compliance with the first 2 TX's each day but fewer received the third JN TX when compared with the HCM devices (p=0.01). JN was tolerated less well than either HCM (p=0.01) or HCMV (p=0.02). The HCMV was tolerated significantly better than the HCM or JN and there were no differences in nocturnal asthma symptoms between groups (p=0.53). Analysis of patient costs to non-study patients for two weeks of therapy (equipment and medications) show a total cost per patient of $45.90 for HCM or HCMV therapy and $52.06 for JN therapy (JN TX require a monthly rental charges of $35). CONCLUSION: These data show that aerosolized albuterol can be effectively administered to young children using either a MDI and HCM, MDI and HCMV or JN. Use of HCM or HCMV is a convenient alternative to JN use and may improve the compliance with the respiratory therapy care plan. Uniformity, consistency and inter-rater reliability of parents' assessments cannot be assured and is a recognized limitation of this study. Supported by Monaghan Medical Corporation