To determine the efficacy of albuterol by metered-dose inhaler (MDI) and spacer compared
to a nebulizer.
A prospective, open-label study.
Large urban emergency department (ED).
All consecutive adult asthma patients over a 2.5-year period.
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.
Pulmonary function, clinical outcome, laboratory data, and financial data were assembled
and analyzed from 2,342 ED visits and 1,420 patients.
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.
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.