Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma

Objective: In children with mild acute asthma, to compare treatment with a single dose of albuterol delivered by a metered dose inhaler (MDI) with a spacer in either a weight-adjusted high dose or a standard low-dose regimen with delivery by a nebulizer. Study design: In this randomized double-blind trial set in an emergency department, 90 children between 5 and 17 years of age with a baseline forced expiratory volume in 1 second (FEV1) between 50% and 79% of predicted value were treated with a single dose of albuterol, either 6 to 10 puffs (n = 30) or 2 puffs (n = 30) with an MDI with spacer or 0.15 mg/kg with a nebulizer (n=30). Results: No significant differences were seen between treatment groups in the degree of improvement in percent predicted FEV1 (P = .12), clinical score, respiratory rate, or O-2 saturation. However, the nebulizer group had a significantly greater change in heart rate (P = .0001). Our study had 93% power to detect a mean difference in percent predicted FEV1 of 8 between the treatment groups. Conclusion: In children with mild acute asthma, treatment with 2 puffs of albuterol by an MDI with spacer is just as clinically beneficial as treatment with higher doses delivered by an MDI or by a nebulizer.