Metered-dose inhaler accessory devices in acute asthma: efficacy and comparison with nebulizers: a literature review.

OBJECTIVES

To evaluate the current literature about the efficacy of providing inhaled medications by metered-dose inhalers and accessory devices (MDI/ADs) to children with acute asthma and to compare it with the current standard of care, small-volume nebulizers (SVNs).

DATA SOURCES

Online computer and manual searches in English-language journal articles published between 1980 and 1996.

STUDY SELECTION

Seventeen prospective clinical trials that have used MDI/ADs in the treatment of acute asthma in children were retrieved. Ten randomized controlled studies that included a comparison with SVN treatment were selected.

DATA EXTRACTION

Studies were assessed qualitatively by their subject characteristics, design, intervention procedures, outcome measures, and results.

DATA SYNTHESIS

There were marked variations in types of MDI/ADs and in doses administered between and within studies. Major outcome measures included pulmonary function measurements and clinical scores. All studies found MDI/ADs to be effective in the treatment of infants and children with acute asthma. Among those who compared this treatment with SVN, 2 found the MDI/AD superior and the rest found it as effective as the SVN.

CONCLUSIONS

The data support the effectiveness of MDI/ADs as first-line treatment in acute childhood asthma. In view of clinical benefit, safety, lower cost, personnel time, and speed and ease of administration of MDI/ADs compared with SVNs, MDI/ADs should be considered the preferred mode of treatment of children with acute asthma.