Metered Dose Inhalers With Holding Chambers versus Nebulizers for Treatment of Acute Asthma management in Pediatric Patients Lyndsey M. Cote, Senior Nursing Student. University of New Hampshire, Class of 2015 BACKGROUND PICO http: //images. meredith. com/parents/images/2010/06/ss_101239190. jpg • Asthma, a restrictive airway disease effects 1 in 11 children. • Leading cause of pediatric hospitalization • 14% of American children have had a diagnosis of asthma at one point in their lifetime • Responsible for 1. 8 million Emergency Room visits and • Asthma was responsible for 439, 400 hospitalizations of adults and children in 2010. • 1 in 5 pediatric patients seen in Emergency Departments across the country are asthma related • Asthma cost society $56 billion in 2007 including medical expenses, loss of productivity, and premature death AIMS/PURPOSE • Asthma exacerbations can be treated in multiple ways. • Typically, an inhaled bronchodilator will be administered via nebulizer or MDI. • Nebulizers have been seen as a gold standard of bronchodilator administration, but new research shows that may not be the case. • A literature review has been performed to determine the best practice for management of acute asthma attacks/exacerbations Is a Metered Dose Inhaler (MDI) with holding chambers (spacers) more effective, at managing an acute asthma exacerbation than a nebulizer in a pediatric patient? RESULTS • Infants and Preschool children have lower hospitalizations and decreased clinical severity when treated with a bronchodilator via MDI with holding chamber compared to nebulizer 2 • Metered dose inhaler with a valved holding chamber is the most preferred method for albuterol delivery in an episode of asthma 9 • MDIs are more cost effective, efficient, and convenient 7 • Equally as effective as nebulizers • Less adverse effects of albuterol when received by MDI versus nebulizer 7 • Significantly less time in ED, increase in pulse, and deterioration in blood gas 8 6 • Nebulizers lead to greater systemic absorption • Parents and patients prefer MDIs with a valved 10, 9 holding chamber over nebulizer • Statistically significant cost savings and hospital 5 admissions • MDIs deliver larger dose deliveries to lungs 10 compared to nebulizers RECOMMENDATION • Metered dose inhaler used with a valved holding chamber is an equally effective method of delivering bronchodilators as nebulizers • Time and cost effective • Less adverse effects with MDIs http: //www. ohsu. edu/blogs/doernbecher/files/2013/06/child-with-spacer. jpg REFERENCES 1. Akinbami, L. J. , Moorman, J. E. , & Liu, X. (2011). Asthma prevalence, health care use, and mortality: United States, 2005– 2009 (32). Center for Disease Control and Prevention-National Center for Health Statistics. 2. Castro-Rodriguez JA, Rodrigo GJ. Beta-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: a systematic review with meta-analysis. J Pediatr 2004; 145: 172– 7. 3. Center for Disease Control and Prevention. (2013). Asthma facts. United States Department of Health and Human Services. 4. Center for Disease Control and Prevention. (n. d. ). Asthma's impact on the nation. Retrieved from http: //www. cdc. gov/asthma/impacts_nation/asthmafactsheet. pdf 5. Doan, Q. , Shefrin, A. , & Johnson, D. (2011). Cost-effectiveness of metered-doseinhalers for asthma exacerbations in the pediatric emergency department. Pediatrics, 127(5), e 1105 -e 1111. 6. Dolovich, M. B. , Ahrens, R. C. , Hess, D. R. , Anderson, P. , Dhand, R. , Rau, J. L. , & Guyatt, G. (2005). Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest, 127(1), 335 -371. 7. Hendeles, L. , Hatton, R. C. , Coons, T. J. , & Carlson, L. (2005). Automatic replacement of albuterol nebulizer therapy by metered-dose inhaler and valved holding chamber. American Journal Of Health-System Pharmacy: AJHP: Official Journal Of The American Society Of Health-System Pharmacists, 62(10), 10531061. 8. Melnyk, B. M. (1999). Building a case for evidence-based practice: inhalers vs. nebulizers. Pediatric Nursing, 25(1), 102. 9. Ortiz-Alvarez, O. , & Mikrogianakis, A. (2012). Managing the paediatric patient with an acute asthma exacerbation. Canadian Paediatric Society. Retrieved from http: //www. cps. ca/documents/position/management-acute-asthma-exacerbation 10. Salyer, J. W. , Di. Blasi, R. M. , Crotwell, D. N. , Cowan, C. A. , & Carter, E. R. (2008). The conversion to metered -dose inhaler with valved holding chamber to administer inhaled albuterol: a pediatric hospital experience. Respiratory care, 53(3), 338 -345.
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