Leversha A M, Campanella S G, Aickin R P, Asher M I
Department of Paediatrics, University of Auckland, and Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
J Pediatr. 2000 Apr;136(4):497-502. doi: 10.1016/s0022-3476(00)90013-1.
To compare the costs and effectiveness of albuterol by metered dose inhaler (MDI) and spacer versus nebulizer in young children with moderate and severe acute asthma.
Randomized, double-blind, placebo-controlled trial in an emergency department at a children's hospital. The participants were children 1 to 4 years of age with moderate to severe acute asthma. Patients assigned to the spacer group received albuterol (600 microg) by MDI by spacer (AeroChamber) followed by placebo by nebulizer (n = 30). The nebulizer group received placebo MDI by spacer followed by 2.5 mg albuterol by nebulizer (n = 30). Treatments were repeated at 20-minute intervals until the patient was judged to need no further doses of bronchodilator, or a total of 6 treatments.
Clinical score, heart rate, respiratory rate, auscultatory findings, and oxygen saturation were recorded at baseline, after each treatment, and 60 minutes after the last treatment. Baseline characteristics and asthma severity were similar for the treatment groups. The spacer was as effective as the nebulizer for clinical score, respiratory rate, and oxygen saturation but produced a greater reduction in wheezing (P =.03). Heart rate increased to a greater degree in the nebulizer group (11.0/min vs 0.17/min for spacer, P <.01). Fewer children in the spacer group required admission (33% vs 60% in the nebulizer group, P =.04, adjusted for sex). No differences were seen in rates of tremor or hyperactivity. The mean cost of each emergency department presentation was NZ$825 for the spacer group and NZ$1282 for the nebulizer group (P =.03); 86% of children and 85% of parents preferred the spacer.
The MDI and spacer combination was a cost-effective alternative to a nebulizer in the delivery of albuterol to young children with moderate and severe acute asthma.
比较定量气雾剂（MDI）加储雾罐与雾化器用于中重度急性哮喘幼儿时的成本和效果。
在一家儿童医院急诊科进行的随机、双盲、安慰剂对照试验。参与者为1至4岁的中重度急性哮喘儿童。分配到储雾罐组的患者通过MDI加储雾罐（爱全乐储雾罐）吸入沙丁胺醇（600微克），随后通过雾化器吸入安慰剂（n = 30）。雾化器组通过储雾罐吸入安慰剂MDI，随后通过雾化器吸入2.5毫克沙丁胺醇（n = 30）。每隔20分钟重复治疗，直至判断患者无需进一步使用支气管扩张剂，或总共进行6次治疗。
在基线、每次治疗后以及最后一次治疗后60分钟记录临床评分、心率、呼吸频率、听诊结果和血氧饱和度。治疗组的基线特征和哮喘严重程度相似。储雾罐在临床评分、呼吸频率和血氧饱和度方面与雾化器效果相同，但在减轻喘息方面效果更佳（P = 0.03）。雾化器组心率升高幅度更大（雾化器组为11.0次/分钟，储雾罐组为0.17次/分钟，P < 0.01）。储雾罐组需要住院的儿童较少（33%，雾化器组为60%，经性别校正后P = 0.04）。震颤或多动发生率无差异。储雾罐组每次急诊科就诊的平均费用为825新西兰元，雾化器组为1282新西兰元（P = 0.03）；86%的儿童和85%的家长更喜欢储雾罐。
在为中重度急性哮喘幼儿提供沙丁胺醇时，MDI加储雾罐组合是一种性价比高的雾化器替代方案。
