Comparison of the bronchodilating effects of albuterol delivered by valved vs. non-valved spacers in pediatric asthma
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Date
2012
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Abstract
Introduction: Inhaled therapy using a metered-dose inhaler (MDI) with attachedvalved holding chamber has been increasingly recognized as the optimal method fordelivering bronchodilators for asthma treatment. However, mainly due to the highcost of these valved holding chambers in many developing countries, the use of non-valved spacers is frequent, despite the scarce evidence that supports their efficacy. Theaim of this study was to compare the bronchodilator response to albuteroladministered by MDI with and without a valved spacer.Methods: In a randomized, two-period, two-sequence crossover clinical trial, weanalyzed 31 stable asthmatic children (6–18 yrs of age) on two consecutive days, whowere randomly assigned to receive 100 lg of albuterol MDI through either a locallyproduced valved spacer or a non-valved spacer. The next day, a crossover treatmentwas employed through the use of the other spacer. Spirometry was recorded beforeand after each albuterol administration.Results: As we were not able to identify any sequence or carryover effect, we tested fortreatment effects in both periods. No significant differences in the absolute change inFEV1(0.20 ± 0.17 vs. 0.18 ± 0.16, p = 0.63), FVC (0.07 ± 0.13 vs. 0.07 ± 0.16,p = 0.88), or MMEF (0.49 ± 0.31 vs. 0.43 ± 0.39, p = 0.53) after bronchodilatoradministration were found between the use of valved and non-valved spacers.Conclusions: In stable asthmatic children, albuterol administered through MDI usinga non-valved spacer produces a bronchodilator response similar to that of a spacerwith a valve that requires an inhalatory opening pressure (with flows between 2 and32 l/min) that even toddlers with bronchial obstruction can easily generate.
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Asthma, Pediatrics, Therapeutics, Inhalation spacers