Division of Pediatrics, Emergency Department, Clinical Hospital, National University of Asunción, Asunción, Paraguay.
Emergency Department, Private Childreńs Institute Asunción, Asunción, Paraguay.
Pediatr Pulmonol. 2019 Apr;54(4):372-377. doi: 10.1002/ppul.24244. Epub 2019 Jan 22.
In moderate-severe asthma exacerbation, salbutamol by inhaler (MDI) is superior to salbutamol delivered by nebulizer (NEB); however, to our knowledge, no studies in children with exclusively severe exacerbations were performed.
To compare the efficacy of salbutamol and ipratropium bromide by MDI versus by NEB in severe asthma exacerbations.
We performed a clinical trial enrolling 103 children (2-14 years of age) with severe asthma exacerbations (defined by the Pulmonary Score ≥ 7) seen at the emergency room in Asuncion, Paraguay. One group received salbutamol and ipratropium (two puff every 10 min for 2 h and then every 30 min for 2 h more) by MDI with a valved-holding chamber and mask along with oxygen by a cannula separately (MDI-SIB); and the other received nebulization with oxygen (NEB-SIB) of salbutamol and ipratropium (1 every 20 min for 2 h and then every 30 min for 2 h more). Primary outcome was the rate of hospitalization (Pulmonary Score ≥ 7) after 4 h and secondary outcome was oxygen saturation.
Fifty two children received MDI-SIB and 51 NEB-SIB. After the 4th hour, children on MDI-SIB had significantly (P = 0.003) lower rate of hospital admission than on NEB-SIB (5.8% vs 27.5%, RR: 0.21 [0.06-0.69], respectively). Similarly, a significant improved clinical score after 60 min and increase in oxygen saturation after 90 min of treatment was observed in MDI-SIB versus NEB-SIB group (4.46 ± 0.7 vs 5.76 ± 0.65, P < 0.00001; and 90.5 ± 1.7 vs 88.43 1 ± 1, P < 0.00001, respectively).
Even in severe asthma exacerbations administration of salbutamol and ipratropium by MDI with valved-holding chamber and mask along with oxygen by a cannula separately was more effective than by a nebulizer.
在中重度哮喘急性发作中，沙丁胺醇吸入剂（MDI）优于沙丁胺醇雾化器（NEB）；然而，据我们所知，尚无研究针对仅发生重度急性发作的患儿进行。
比较沙丁胺醇和异丙托溴铵通过 MDI 与通过 NEB 治疗重度哮喘急性发作的疗效。
我们进行了一项临床试验，纳入了 103 名在巴拉圭亚松森急诊就诊的重度哮喘急性发作患儿（定义为肺部评分≥7）。一组患儿接受沙丁胺醇和异丙托溴铵（每 10 分钟 2 喷，持续 2 小时，然后每 30 分钟 2 小时，接着每 30 分钟 2 小时），通过带活瓣的储雾罐和面罩吸入，同时通过单独的套管给氧（MDI-SIB）；另一组患儿接受沙丁胺醇和异丙托溴铵雾化治疗（2 小时内每 20 分钟 1 次，然后每 30 分钟 2 小时），同时给氧（NEB-SIB）。主要结局是 4 小时后住院率（肺部评分≥7），次要结局是氧饱和度。
52 名患儿接受 MDI-SIB，51 名患儿接受 NEB-SIB。在第 4 小时时，MDI-SIB 组患儿的住院率显著低于 NEB-SIB 组（5.8% vs 27.5%，RR：0.21[0.06-0.69]）（P=0.003）。同样，MDI-SIB 组患儿在 60 分钟时的临床评分显著改善，在 90 分钟时的氧饱和度增加（4.46±0.7 vs 5.76±0.65，P<0.00001；90.5±1.7 vs 88.43±1.0，P<0.00001）。
即使在重度哮喘急性发作中，通过带活瓣的储雾罐和面罩吸入沙丁胺醇和异丙托溴铵，同时通过套管给氧，也比通过雾化器更有效。
