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February 1994, Vol 148, No. 2 >
Article | February 1994

Albuterol Delivered via Metered-Dose Inhaler With Spacer for Outpatient Treatment of Young Children With Wheezing FREE

Robert W. Hickey, MD; Robert F. Gochman, MD; Vidya Chande, MD; Holly W. Davis, MD
Arch Pediatr Adolesc Med. 1994;148(2):189-194. doi:10.1001/archpedi.1994.02170020075013.
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Objective:  To determine the efficacy of albuterol delivered via metered-dose inhaler with spacer for the treatment of wheezing infants.

Design and Setting:  Double-blind, prospective, placebocontrolled, clinical crossover trial undertaken at the emergency department of a university-affiliated children's hospital.

Participants:  Forty-two patients aged 1 to 18 months presenting to the emergency department with wheezing.

Intervention:  Subjects were randomly assigned to one of two blinded treatment groups. Group 1 received two albuterol treatments followed by two placebo treatments. Group 2 received two placebo treatments followed by two albuterol treatments. Each treatment consisted of two puffs from a metered-dose inhaler with spacer at 20-minute intervals.

Measurements/Main Results:  On enrollment and 20 minutes after each treatment, a clinical assessment was made by the principal investigator, which included heart rate, respiratory rate, pulse oximetry, wheezing score (0 to 3), and retraction score (0 to 3). Both treatment groups had statistically significant improvement in mean wheezing score associated with albuterol therapy (P<.05 using Dunnett's t test). Mean retraction score improved over time in both groups only during drug therapy. However, the improvement of only group 2 reached statistical significance (P<.05 using Dunnett's t test). Scores were then classified as "improved" and "not improved" for analysis with McNemar's test. Group 2 had a statistically significant proportion of patients with improved retraction score related to albuterol therapy. The remaining dichotomized results, while not achieving statistical significance, showed a trend in the direction expected from a beneficial drug effect.

Conclusions:  Albuterol delivered by metered-dose inhaler with spacer to wheezing infants aged 1 to 18 months reduces the severity of wheezing and retractions.(Arch Pediatr Adolesc Med. 1994;148:189-194)

REFERENCES

1 +
Henderson FW, Clyde Jr, WA, Collier AM, et al.  The etiologic and epidemiologic spectrum of bronchiolitis in pediatric practice . J Pediatr . 1979;;95:183-191.
2 +
Taussig LM.  The conundrum of wheezing and airway hyperreactivity in infancy . Pediatr Pulmonol . 1992;;13:1-3.
3 +
Lowell DI, Lister G, Von Koss H, McCarthy P.  Wheezing in infants: the response to epinephrine . Pediatrics . 1987;;79:939-945.
4 +
Schuh S, Canny G, Reisman JJ, et al.  Nebulized albuterol in acute bronchiolitis . Pediatr Pharmacol Ther . 1990;;117:633-637.
5 +
Klassen TP, Rowe PC, Sutcliffe T, Ropp LJ, McDowell IW, Li MM.  Randomized trial of salbutamol in acute bronchiolitis . Pediatr Pharmacol Ther . 1991;;118:807-811.
6 +
Alario AJ, Lewander WJ, Dennehy P, Seifer R, Mansell AL.  The efficacy of nebulized metaproterenol in wheezing infants and young children . AJDC . 1992;; 146:412-418.
7 +
Schweich PJ, Hurt TL, Walkley El, Mullen N, Archibald LF.  The use of nebulized albuterol in wheezing infants . Pediatr Emerg Care . 1992;;8:184-188.
8 +
Winer BJ.  Design and analysis of single-factor experiments . In: Statistical Principles in Experimental Design . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1971;:201-204.
9 +
Holland WW, Colley JRT, Barraclough MA.  Measurement of respiratory effort and assessment of a method of treating lower-respiratory-tract infections in small children . Lancet . 1960;;2:1166-1167.
10 +
Soto ME, Sly PD, Uren E, Taussig LM, Landau LI.  Bronchodilator response during acute viral bronchiolitis in infancy . Pediatr Pulmonol . 1985;;1:85-90.
11 +
Mallory Jr, GB, Motoyama EK, Koumbourlis AC, Mutich RL, Nakayama DK.  Bronchial reactivity in infants in acute respiratory failure with viral bronchiolitis . Pediatr Pulmonol . 1989;;6:253-259.
12 +
Phelan PD, Williams HE.  Sympathetic drugs in acute viral bronchiolitis: their effect on pulmonary resistance . Pediatrics . 1969;;44:493-497.
13 +
Radford M.  Effect of salbutamol in infants with wheezy bronchitis . Arch Dis Child . 1975;;50:535-538.
14 +
Rutter N, Milner AD, Hiller EJ.  Effect of bronchodilators on respiratory resistance in infants and young children with bronchiolitis and wheezy bronchitis . Arch Dis Child . 1975;;50:719-722.
15 +
Lenney W, Milner AD.  Alpha and beta adrenergic stimulants in bronchiolitis and wheezy bronchitis in children under 18 months of age . Arch Dis Child . 1978;;53:707-709.
16 +
Hughes DM, Lesouëf PN, Landau LI.  Effect of salbutamol on respiratory mechanics in bronchiolitis . Pediatr Res . 1987;;22:83-86.
17 +
Sly PD, Lanteri CJ, Raven JM.  Do wheezy infants recovering from bronchiolitis respond to inhaled salbutamol? Pediatr Pulmonol . 1991;;10:36-39.
18 +
Mallol J, Sly PD.  Effect of chloral hydrate on arterial oxygen saturation in wheezy infants . Pediatr Pulmonol . 1988;;5:96-99.
19 +
Heimer D, Shim C, Williams MH.  The effect of sequential inhalations of metaproterenol aerosol in asthma . J Allergy Clin Immunol . 1980;;66:75-77.
20 +
Godfrey S, Beardsmore CS, Maayan C, Bar-Yishay E.  Can thoracic gas volume be measured in infants with airways obstruction? Am Rev Respir Dis . 1986;; 133:245-251.
21 +
Mallol J, Hibbert ME, Robertson CF, Olinsky A, Phelan PD, Sly PD.  Inherent variability of pulmonary function tests in infants with bronchiolitis . Pediatr Pulmonol . 1988;;5:152-157.
22 +
Stanescu D.  Was it just our problem, or yours too? errors in body plethysmography, in infants, children, and adults . Pediatr Pulmonol . 1991;;11:285-288.
23 +
Mallol J, Barrueto L, Girardi G, et al.  Use of nebulized bronchodilators in infants under 1 year of age: analysis of four forms of therapy . Pediatr Pulmonol . 1987;;3:298-303.
24 +
Mallol J, Barrueto L, Girardi G, Toro O.  Bronchodilator effect of fenoterol and ipratropium bromide in infants with acute wheezing . Pediatr Pulmonol . 1987;; 3:352-356.
25 +
Lines DR, Kattampallil JS, Liston P.  Efficacy of nebulised salbutamol in bronchiolitis . Pediatr Rev Commun . 1990;;5:121-129.
26 +
Wennergren G, Kristjánsson S, Sten G, Bjure J, Engström I.  Nebulized racemic adrenaline for wheezy bronchitis . Acta P}diatr Scand . 1991;;80:375-377.
27 +
Wang ELL, Milner R, Allen U, Maj H.  Bronchodilators for treatment of mild bronchiolitis: a factorial randomized trial . Arch Dis Child . 1992;;67:289-293.
28 +
Commey JOO, Levison H.  Physical signs in childhood asthma . Pediatrics . 1976;; 58:537-541.
29 +
Kerem E, Canny G, Tibshirani R, et al.  Clinical-physiologic correlations in acute asthma of childhood . Pediatrics . 1992;;87:481-486.
30 +
McFadden Jr ER, Kiser R, deGroot WJ.  Acute bronchial asthma . N Engl J Med . 1973;;288:221-225.
31 +
Larsson S, Svedmyr N.  Bronchodilating effect and side effects of beta2-adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof): a study with salbutamol in asthmatics . Am Rev Respir Dis . 1977;;116:861-869.
32 +
Blake KV, Hoppe M, Harman E, Hendeles L.  Relative amount of albuterol delivered to lung receptors from a metered-dose inhaler and nebulizer solution: bioassay by histamine bronchoprovocation . Chest . 1992;;101:309-315.
33 +
O'Callaghan C, Milner AD, Swarbrick A.  Spacer device with face mask attachment for giving bronchodilators to infants with asthma . BMJ . 1988;;298:160-161.
34 +
Conner WT, Dolovich MB, Frame RA, Newhouse MT.  Reliable salbutamol administration in 6- to 36-month-old children by means of a metered dose inhaler and aerochamber with mask . Pediatr Pulmonol . 1989;;6:263-267.
35 +
Yuksel B, GreenoughA, Maconochie I.  Effectivebronchodilator treatment by a simple spacer device for wheezy premature infants . Arch Dis Child . 1990;;65:782-785.
36 +
Kim CS, Eldridge MA, Sackner MA.  Oropharyngeal deposition and delivery aspects of metered-dose inhaler aerosols . Am Rev Respir Dis . 1987;;135:157-164.
37 +
Everard ML, Clark AR, Milner AD.  Drug delivery from holding chambers with attached facemask . Arch Dis Child . 1992;;67:580-585.
38 +
Blake KV, Hoppe M, Harman E, Hendeles L.  Relative amount of albuterol delivered to lung receptors from a metered-dose inhaler and nebulizer solution . Chest . 1992;;101:309-315.
39 +
Spitzer WO, Suissa S, Ernst P, et al.  The use of β-agonists and the risk of death from asthma . N Engl J Med . 1992;;326:501-506.
40 +
Burrows B, Lebowitz MD.  The β-agonist dilemma . N Engl J Med . 1992;;326: 560-561.
41 +
Sears MR, Rea HH, Beaglehole R, et al.  Asthma mortality in New Zealand: a two year national study . N Z Med J . 1985;;98:271-275.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Henderson FW, Clyde Jr, WA, Collier AM, et al.  The etiologic and epidemiologic spectrum of bronchiolitis in pediatric practice . J Pediatr . 1979;;95:183-191.
2 +
Taussig LM.  The conundrum of wheezing and airway hyperreactivity in infancy . Pediatr Pulmonol . 1992;;13:1-3.
3 +
Lowell DI, Lister G, Von Koss H, McCarthy P.  Wheezing in infants: the response to epinephrine . Pediatrics . 1987;;79:939-945.
4 +
Schuh S, Canny G, Reisman JJ, et al.  Nebulized albuterol in acute bronchiolitis . Pediatr Pharmacol Ther . 1990;;117:633-637.
5 +
Klassen TP, Rowe PC, Sutcliffe T, Ropp LJ, McDowell IW, Li MM.  Randomized trial of salbutamol in acute bronchiolitis . Pediatr Pharmacol Ther . 1991;;118:807-811.
6 +
Alario AJ, Lewander WJ, Dennehy P, Seifer R, Mansell AL.  The efficacy of nebulized metaproterenol in wheezing infants and young children . AJDC . 1992;; 146:412-418.
7 +
Schweich PJ, Hurt TL, Walkley El, Mullen N, Archibald LF.  The use of nebulized albuterol in wheezing infants . Pediatr Emerg Care . 1992;;8:184-188.
8 +
Winer BJ.  Design and analysis of single-factor experiments . In: Statistical Principles in Experimental Design . 2nd ed. New York, NY: McGraw-Hill International Book Co; 1971;:201-204.
9 +
Holland WW, Colley JRT, Barraclough MA.  Measurement of respiratory effort and assessment of a method of treating lower-respiratory-tract infections in small children . Lancet . 1960;;2:1166-1167.
10 +
Soto ME, Sly PD, Uren E, Taussig LM, Landau LI.  Bronchodilator response during acute viral bronchiolitis in infancy . Pediatr Pulmonol . 1985;;1:85-90.
11 +
Mallory Jr, GB, Motoyama EK, Koumbourlis AC, Mutich RL, Nakayama DK.  Bronchial reactivity in infants in acute respiratory failure with viral bronchiolitis . Pediatr Pulmonol . 1989;;6:253-259.
12 +
Phelan PD, Williams HE.  Sympathetic drugs in acute viral bronchiolitis: their effect on pulmonary resistance . Pediatrics . 1969;;44:493-497.
13 +
Radford M.  Effect of salbutamol in infants with wheezy bronchitis . Arch Dis Child . 1975;;50:535-538.
14 +
Rutter N, Milner AD, Hiller EJ.  Effect of bronchodilators on respiratory resistance in infants and young children with bronchiolitis and wheezy bronchitis . Arch Dis Child . 1975;;50:719-722.
15 +
Lenney W, Milner AD.  Alpha and beta adrenergic stimulants in bronchiolitis and wheezy bronchitis in children under 18 months of age . Arch Dis Child . 1978;;53:707-709.
16 +
Hughes DM, Lesouëf PN, Landau LI.  Effect of salbutamol on respiratory mechanics in bronchiolitis . Pediatr Res . 1987;;22:83-86.
17 +
Sly PD, Lanteri CJ, Raven JM.  Do wheezy infants recovering from bronchiolitis respond to inhaled salbutamol? Pediatr Pulmonol . 1991;;10:36-39.
18 +
Mallol J, Sly PD.  Effect of chloral hydrate on arterial oxygen saturation in wheezy infants . Pediatr Pulmonol . 1988;;5:96-99.
19 +
Heimer D, Shim C, Williams MH.  The effect of sequential inhalations of metaproterenol aerosol in asthma . J Allergy Clin Immunol . 1980;;66:75-77.
20 +
Godfrey S, Beardsmore CS, Maayan C, Bar-Yishay E.  Can thoracic gas volume be measured in infants with airways obstruction? Am Rev Respir Dis . 1986;; 133:245-251.
21 +
Mallol J, Hibbert ME, Robertson CF, Olinsky A, Phelan PD, Sly PD.  Inherent variability of pulmonary function tests in infants with bronchiolitis . Pediatr Pulmonol . 1988;;5:152-157.
22 +
Stanescu D.  Was it just our problem, or yours too? errors in body plethysmography, in infants, children, and adults . Pediatr Pulmonol . 1991;;11:285-288.
23 +
Mallol J, Barrueto L, Girardi G, et al.  Use of nebulized bronchodilators in infants under 1 year of age: analysis of four forms of therapy . Pediatr Pulmonol . 1987;;3:298-303.
24 +
Mallol J, Barrueto L, Girardi G, Toro O.  Bronchodilator effect of fenoterol and ipratropium bromide in infants with acute wheezing . Pediatr Pulmonol . 1987;; 3:352-356.
25 +
Lines DR, Kattampallil JS, Liston P.  Efficacy of nebulised salbutamol in bronchiolitis . Pediatr Rev Commun . 1990;;5:121-129.
26 +
Wennergren G, Kristjánsson S, Sten G, Bjure J, Engström I.  Nebulized racemic adrenaline for wheezy bronchitis . Acta P}diatr Scand . 1991;;80:375-377.
27 +
Wang ELL, Milner R, Allen U, Maj H.  Bronchodilators for treatment of mild bronchiolitis: a factorial randomized trial . Arch Dis Child . 1992;;67:289-293.
28 +
Commey JOO, Levison H.  Physical signs in childhood asthma . Pediatrics . 1976;; 58:537-541.
29 +
Kerem E, Canny G, Tibshirani R, et al.  Clinical-physiologic correlations in acute asthma of childhood . Pediatrics . 1992;;87:481-486.
30 +
McFadden Jr ER, Kiser R, deGroot WJ.  Acute bronchial asthma . N Engl J Med . 1973;;288:221-225.
31 +
Larsson S, Svedmyr N.  Bronchodilating effect and side effects of beta2-adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof): a study with salbutamol in asthmatics . Am Rev Respir Dis . 1977;;116:861-869.
32 +
Blake KV, Hoppe M, Harman E, Hendeles L.  Relative amount of albuterol delivered to lung receptors from a metered-dose inhaler and nebulizer solution: bioassay by histamine bronchoprovocation . Chest . 1992;;101:309-315.
33 +
O'Callaghan C, Milner AD, Swarbrick A.  Spacer device with face mask attachment for giving bronchodilators to infants with asthma . BMJ . 1988;;298:160-161.
34 +
Conner WT, Dolovich MB, Frame RA, Newhouse MT.  Reliable salbutamol administration in 6- to 36-month-old children by means of a metered dose inhaler and aerochamber with mask . Pediatr Pulmonol . 1989;;6:263-267.
35 +
Yuksel B, GreenoughA, Maconochie I.  Effectivebronchodilator treatment by a simple spacer device for wheezy premature infants . Arch Dis Child . 1990;;65:782-785.
36 +
Kim CS, Eldridge MA, Sackner MA.  Oropharyngeal deposition and delivery aspects of metered-dose inhaler aerosols . Am Rev Respir Dis . 1987;;135:157-164.
37 +
Everard ML, Clark AR, Milner AD.  Drug delivery from holding chambers with attached facemask . Arch Dis Child . 1992;;67:580-585.
38 +
Blake KV, Hoppe M, Harman E, Hendeles L.  Relative amount of albuterol delivered to lung receptors from a metered-dose inhaler and nebulizer solution . Chest . 1992;;101:309-315.
39 +
Spitzer WO, Suissa S, Ernst P, et al.  The use of β-agonists and the risk of death from asthma . N Engl J Med . 1992;;326:501-506.
40 +
Burrows B, Lebowitz MD.  The β-agonist dilemma . N Engl J Med . 1992;;326: 560-561.
41 +
Sears MR, Rea HH, Beaglehole R, et al.  Asthma mortality in New Zealand: a two year national study . N Z Med J . 1985;;98:271-275.

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