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Albuterol Administered by Metered-Dose Inhaler and Spacer to Young Children With Wheezing

Edward R. Carter, MC, USA
Arch Pediatr Adolesc Med. 1994;148(12):1352-1353. doi:10.1001/archpedi.1994.02170120114026.
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The use of a spacer with face mask to administer aerosolized medication to infants and toddlers is controversial. Hickey et al1 evaluated the use of a "homemade" spacer to administer low-dose albuterol (two puffs, or 180 μg given twice, 20 minutes apart) to infants and toddlers presenting to the emergency department with wheezing. The study has problems that make it difficult for me to accept the authors' conclusions that the low dose of albuterol they administered via spacer with face mask to young children presenting to the emergency department with wheezing resuited in significant clinical improvement. I also believe that this study and its conclusions send a wrong message: low-dose albuterol administered via metered-dose inhaler with a spacer (MDI-S) and face mask is an acceptable alternative to standard nebulizer therapy in infants and toddlers. I note the following three major problems with the study: (1) the spacer device employed;

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