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September 1997

Metered-Dose Inhaler Accessory Devices in Acute Asthma: Efficacy and Comparison With Nebulizers: A Literature Review

Author Affiliations

From The Children's Hospital of Philadelphia, University of Pennsylvania Medical School, Philadelphia, Pa (Dr Amirav), and the Barnett Medical Aerosol Research Laboratory, St Joseph's Hospital/McMaster University, Hamilton, Ontario (Dr Newhouse). Dr Amirav is now with the Department of Pediatrics, Rebecca Sieff Hospital, Safed, Israel.

Arch Pediatr Adolesc Med. 1997;151(9):876-882. doi:10.1001/archpedi.1997.02170460014003

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.Arch Pediatr Adolesc Med. 1997;151:876-882

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