Vangveeravong Mukda
Allergy Unit, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand.
J Med Assoc Thai. 2008 Oct;91 Suppl 3:S115-23.
Rapid-acting inhaled beta-2 agonist is standard treatment in acute asthmatic patient; it causes smooth muscle dilatation, gives rapid action and has less side effect compared with parenteral and oral form. There are many forms of inhaler including nebulization, MDI and DPI. In Thailand the most common form of salbutamol administration for the treatment of acute exacerbation of asthma is via nebulization.
To compare the clinical effectiveness and side effects of salbutamol via MDI with Volumatic spacer and via DPI (Easyhaler), with nebulization in mild to moderate severity of acute asthma exacerbation in childhood.
A prospective, randomized controlled study in children, aged 5- 18-years-old with mild to moderate severe asthmatic attack, is done at the Emergency Room, QSNICH during October 2004 to February 2006. These children with acute asthma attack are randomly-assigned to 3 groups of different salbutamol administrations: group 1 via nebulization, group 2 via MDI with volumatic spacer and group 3 via DPI (Easyhaler). Salbutamol is administered and clinical responses: asthma score, oxygen saturation, PR, RR, BP and side effects (tremor and palpitation) are recorded at 0, 20, 40 and 60 minutes after the drug administrations. The drug will be repeated every 20 minutes for the total maximum of 3 times. If there is no clinical improvement, they will be admitted to the hospital for further management.
There are 54 asthmatic children, 35 male (64.8%) and 19 female (35.2%). Their mean age is 8.4 +/- 2.3 years. There are 18patients in each group. There is no significant difference in efficacy of salbutamol among the 3 groups as measured by asthma score, O2 saturation, PR, RR and BP Tremor are equally observed in all 3 groups (5.5%) while palpitation are observed in 11.1% of group 1 and 2 only. One patient in group 2 and 3 are admitted while no patient in group 1 is.
Rapid-acting inhaled beta-2 agonist via MDI with volumatic spacer and DPI (Easyhaler) can be used effectively compared with nebulization form in treating mild to moderate degrees of acute exacerbation of asthma in children with comparable side effects.
速效吸入型β-2激动剂是急性哮喘患者的标准治疗药物；它可使平滑肌舒张，起效迅速，与肠胃外给药和口服剂型相比副作用更少。吸入器有多种形式，包括雾化器、定量吸入器（MDI）和干粉吸入器（DPI）。在泰国，治疗哮喘急性加重时最常用的沙丁胺醇给药方式是雾化吸入。
比较在儿童轻度至中度急性哮喘加重期，使用带储雾罐的MDI和DPI（易纳器）吸入沙丁胺醇与雾化吸入的临床疗效和副作用。
2004年10月至2006年2月在QSNICH急诊室对5至18岁患有轻度至中度严重哮喘发作的儿童进行了一项前瞻性随机对照研究。这些急性哮喘发作的儿童被随机分为3组，接受不同的沙丁胺醇给药方式：第1组通过雾化吸入，第2组通过带储雾罐的MDI吸入，第3组通过DPI（易纳器）吸入。给予沙丁胺醇后，在给药后0、20、40和60分钟记录临床反应：哮喘评分、血氧饱和度、脉率、呼吸频率、血压和副作用（震颤和心悸）。药物每20分钟重复使用一次，最多使用3次。如果临床症状无改善，将收住入院进一步治疗。
共有54例哮喘儿童，男性35例（64.8%），女性19例（35.2%）。他们的平均年龄为8.4±2.3岁。每组18例患者。通过哮喘评分、血氧饱和度、脉率、呼吸频率和血压测量，3组之间沙丁胺醇的疗效无显著差异。所有3组均观察到震颤（5.5%），而仅在第1组和第2组观察到心悸（11.1%）。第2组和第3组各有1例患者收住入院，第1组无患者收住入院。
与雾化吸入方式相比，在治疗儿童轻度至中度急性哮喘加重期时，带储雾罐的MDI和DPI（易纳器）吸入速效β-2激动剂同样有效，且副作用相当。
