定量气雾剂加一次性储物罐与雾化器用于急性哮喘治疗时支气管扩张剂给药的疗效及成本比较

Efficacy and cost comparisons of bronchodilatator administration between metered dose inhalers with disposable spacers and nebulizers for acute asthma treatment.

作者信息

Dhuper Sunil, Chandra Alpana, Ahmed Aziz, Bista Sabin, Moghekar Ajit, Verma Rajesh, Chong Cynthia, Shim Chang, Cohen Hillel, Choksi Sonia

机构信息

North Central Bronx Hospital, Bronx, New York, USA.

出版信息

J Emerg Med. 2011 Mar;40(3):247-55. doi: 10.1016/j.jemermed.2008.06.029. Epub 2008 Dec 11.

DOI:10.1016/j.jemermed.2008.06.029

PMID:19081697

Abstract

BACKGROUND

Despite demonstration of equivalent efficacy of beta agonist delivery using a metered dose inhaler (MDI) with spacer vs. nebulizer in asthma patients, use of a nebulizer remains standard practice.

OBJECTIVES

We hypothesize that beta agonist delivery with a MDI/disposable spacer combination is an effective and low-cost alternative to nebulizer delivery for acute asthma in an inner-city population.

METHODS

This study was a prospective, randomized, double-blinded, placebo-controlled trial with 60 acute asthma adult patients in two inner-city emergency departments. Subjects (n = 60) received albuterol with either a MDI/spacer combination or nebulizer. The spacer group (n = 29) received albuterol by MDI/spacer followed by placebo nebulization. The nebulizer group (n = 29) received placebo by MDI/spacer followed by albuterol nebulization. Peak flows, symptom scores, and need for rescue bronchodilatator were monitored. Median values were compared with the Kolmogorov-Smirnov test.

RESULTS

Patients in the two randomized groups had similar baseline characteristics. The severity of asthma exacerbation, median peak flows, and symptom scores were not significantly different between the two groups. The median (interquartile range) improvement in peak flow was 120 (75-180) L/min vs. 120 (80-155) L/min in the spacer and nebulizer groups, respectively (p = 0.56). The median improvement in the symptom score was 7 (5-9) vs. 7 (4-9) in the spacer and nebulizer groups, respectively (p = 0.78). The median cost of treatment per patient was $10.11 ($10.03-$10.28) vs. $18.26 ($9.88-$22.45) in the spacer and nebulizer groups, respectively (p < 0.001).

CONCLUSION

There is no evidence of superiority of nebulizer to MDI/spacer beta agonist delivery for emergency management of acute asthma in the inner-city adult population. MDI/spacer may be a more economical alternative to nebulizer delivery.

摘要

背景

尽管已证明在哮喘患者中使用带储雾罐的定量吸入器（MDI）与雾化器递送β激动剂的疗效相当，但雾化器的使用仍是标准做法。

目的

我们假设，对于市中心城区人群的急性哮喘，使用MDI/一次性储雾罐组合递送β激动剂是一种有效且低成本的替代雾化器递送的方法。

方法

本研究是一项前瞻性、随机、双盲、安慰剂对照试验，在两个市中心城区急诊科纳入了60例急性哮喘成年患者。受试者（n = 60）接受沙丁胺醇，给药方式为MDI/储雾罐组合或雾化器。储雾罐组（n = 29）通过MDI/储雾罐接受沙丁胺醇，随后进行安慰剂雾化。雾化器组（n = 29）通过MDI/储雾罐接受安慰剂，随后进行沙丁胺醇雾化。监测峰值流速、症状评分以及使用急救支气管扩张剂的需求。中位数采用柯尔莫哥洛夫-斯米尔诺夫检验进行比较。

结果

两个随机分组的患者基线特征相似。两组之间哮喘加重的严重程度、中位数峰值流速和症状评分无显著差异。储雾罐组和雾化器组峰值流速的中位数（四分位间距）改善分别为120（75 - 180）L/分钟和120（80 - 155）L/分钟（p = 0.56）。储雾罐组和雾化器组症状评分的中位数改善分别为7（5 - 9）和7（4 - 9）（p = 0.78）。储雾罐组和雾化器组每位患者的治疗费用中位数分别为10.11美元（10.03 - 10.28美元）和18.26美元（9.88 - 22.45美元）（p < 0.001）。