9/18/03 Delivery of inhaled beta agonists by metered dose inhaler with spacer vs nebulizer in the treatment of acute asthmaSummaryInhaled short acting beta agonists (IBA) have been delivered in high doses by power nebulization (Neb) in the treatment of acute asthma exacerbations. However, some previous studies have suggested that delivery of such IBA by a metered dose inhaler with an attached spacer (MDI/S) can be as effective as Neb delivery in such situations. Cates of the Bushey Health Center in the UK carried out review of the Cochrane database of controlled, randomized studies comparing clinical effects of IBA delivered by MDI/S vs Neb in the treatment of acute, non-life threatening asthma exacerbations. He found no significant differences between the effects of IBA delivered by the 2 delivery systems in adults treated. The efficacy of the 2 delivery systems in older children with possibly few adverse side effects experienced during the MDI/S delivery of the IBA. The response of individual asthmatics to IBA therapy cannot always be predicted. However, the problem can be overcome by use of frequent repeated doses by either Neb or MDI/S every 15 minutes titrated against the clinical response of the patient. Reference Respir Med 2003;97:762-9 Editor’s Comments The conclusions reached in this current Cochrane database analysis are similar to that in a previous report of Neb vs MDI/S delivery of IBA treatment of acute asthma by this author (Cochrane Database Syst Rev 2002; CD 000052). In both cases, it is assumed that the asthmatic patient can handle the activation of the MDI appropriately. The use of an attached spacer reduces the need for adequate timing of MDI activation with slow, deep inhalation. Also, the likely availability of trained staff to help the patient with inhalation technique in the Emergency Department makes use of the MDI/S feasible at lower cost than Neb use (and possibly less systemic adverse effects). However, IBA delivery by Neb may still be preferable in the treatment of acute asthma in very young children. Of note, a previous review by Hill of existent studies showed no differences in the efficacy of inhaled corticosteroids delivered by nebulizer vs MDI/spacer in the treatment of chronic asthma (Thorax 1999; 54:661-63).
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