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A comparison of albuterol administered by metered-dose inhaler and spacer with albuterol by nebulizer in adults presenting to an urban emergency department with acute asthma.

Abstract

STUDY OBJECTIVES

To determine the efficacy of albuterol by metered-dose inhaler (MDI) and spacer compared to a nebulizer.

DESIGN

A prospective, open-label study.

SETTING

Large urban emergency department (ED).

PATIENTS

All consecutive adult asthma patients over a 2.5-year period.

INTERVENTIONS

ED personnel used a standardized treatment algorithm, which included albuterol administered by nebulization, for patients presenting to the ED during the first 12 months of the study. The treatment algorithm then was switched to one that utilized albuterol administered by MDI/spacer as the primary mode of delivery for the following 18 months. As part of the conversion to MDI/spacer, ED staff counseled patients on self-management and supplied patients with a peak flowmeter, an MDI/spacer, and an inhaled steroid for home use.

MEASUREMENTS

Pulmonary function, clinical outcome, laboratory data, and financial data were assembled and analyzed from 2,342 ED visits and 1,420 patients.

RESULTS

While there was no significant difference in hospital admission rates between patients in the MDI/spacer group and the nebulizer group (13.2% and 14.6%, respectively), there was a statistically greater improvement in peak flow rates in the MDI/spacer group (126.8 vs 111.9 L/min, respectively; p = 0.002). The MDI/spacer group also spent significantly less time in the ED (163.6 and 175 min, respectively; p = 0.007), had a lower total albuterol dose (1,125 microg and 6,700 microg, respectively; p < 0.001), and showed a greater improvement in arterial oxygen saturation (p = 0.043). Relapse rates at 14 and 21 days were significantly lower (p < 0.01 and p < 0.05, respectively) among patients treated with the MDI/spacer and were associated with asthma education and the provision of a peak flowmeter, a spacer, and an inhaled corticosteroid for patients' home use.

CONCLUSIONS

Albuterol administered by MDI/spacer is an efficacious and cost-effective alternative to nebulization in adults with acute asthma who present at a large urban ED.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    University of Cincinnati Medical Center, Cincinnati, OH, USA. kenneth_newman@msn.com

    , ,

    Source

    Chest 121:4 2002 Apr pg 1036-41

    MeSH

    Acute Disease
    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Albuterol
    Asthma
    Child
    Dose-Response Relationship, Drug
    Emergencies
    Emergency Service, Hospital
    Female
    Hospitals, Urban
    Humans
    Male
    Middle Aged
    Nebulizers and Vaporizers
    Ohio
    Oxygen
    Peak Expiratory Flow Rate
    Prospective Studies
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    11948030

    Citation

    Newman, Kenneth B., et al. "A Comparison of Albuterol Administered By Metered-dose Inhaler and Spacer With Albuterol By Nebulizer in Adults Presenting to an Urban Emergency Department With Acute Asthma." Chest, vol. 121, no. 4, 2002, pp. 1036-41.
    Newman KB, Milne S, Hamilton C, et al. A comparison of albuterol administered by metered-dose inhaler and spacer with albuterol by nebulizer in adults presenting to an urban emergency department with acute asthma. Chest. 2002;121(4):1036-41.
    Newman, K. B., Milne, S., Hamilton, C., & Hall, K. (2002). A comparison of albuterol administered by metered-dose inhaler and spacer with albuterol by nebulizer in adults presenting to an urban emergency department with acute asthma. Chest, 121(4), pp. 1036-41.
    Newman KB, et al. A Comparison of Albuterol Administered By Metered-dose Inhaler and Spacer With Albuterol By Nebulizer in Adults Presenting to an Urban Emergency Department With Acute Asthma. Chest. 2002;121(4):1036-41. PubMed PMID: 11948030.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A comparison of albuterol administered by metered-dose inhaler and spacer with albuterol by nebulizer in adults presenting to an urban emergency department with acute asthma. AU - Newman,Kenneth B, AU - Milne,Scott, AU - Hamilton,Cathy, AU - Hall,Kent, PY - 2002/4/12/pubmed PY - 2002/5/10/medline PY - 2002/4/12/entrez SP - 1036 EP - 41 JF - Chest JO - Chest VL - 121 IS - 4 N2 - STUDY OBJECTIVES: To determine the efficacy of albuterol by metered-dose inhaler (MDI) and spacer compared to a nebulizer. DESIGN: A prospective, open-label study. SETTING: Large urban emergency department (ED). PATIENTS: All consecutive adult asthma patients over a 2.5-year period. INTERVENTIONS: ED personnel used a standardized treatment algorithm, which included albuterol administered by nebulization, for patients presenting to the ED during the first 12 months of the study. The treatment algorithm then was switched to one that utilized albuterol administered by MDI/spacer as the primary mode of delivery for the following 18 months. As part of the conversion to MDI/spacer, ED staff counseled patients on self-management and supplied patients with a peak flowmeter, an MDI/spacer, and an inhaled steroid for home use. MEASUREMENTS: Pulmonary function, clinical outcome, laboratory data, and financial data were assembled and analyzed from 2,342 ED visits and 1,420 patients. RESULTS: While there was no significant difference in hospital admission rates between patients in the MDI/spacer group and the nebulizer group (13.2% and 14.6%, respectively), there was a statistically greater improvement in peak flow rates in the MDI/spacer group (126.8 vs 111.9 L/min, respectively; p = 0.002). The MDI/spacer group also spent significantly less time in the ED (163.6 and 175 min, respectively; p = 0.007), had a lower total albuterol dose (1,125 microg and 6,700 microg, respectively; p < 0.001), and showed a greater improvement in arterial oxygen saturation (p = 0.043). Relapse rates at 14 and 21 days were significantly lower (p < 0.01 and p < 0.05, respectively) among patients treated with the MDI/spacer and were associated with asthma education and the provision of a peak flowmeter, a spacer, and an inhaled corticosteroid for patients' home use. CONCLUSIONS: Albuterol administered by MDI/spacer is an efficacious and cost-effective alternative to nebulization in adults with acute asthma who present at a large urban ED. SN - 0012-3692 UR - https://www.unboundmedicine.com/medline/citation/11948030/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(15)34277-X DB - PRIME DP - Unbound Medicine ER -