Inhalers or nebulisation of salbutamol in childhood asthma exacerbations in emergency departments

Abstract

Purpose

Asthma exacerbations often lead to paediatric emergency department (PED) visits, but evidence for paediatric management remains limited, and recommendations under discussion. This study compared salbutamol delivered via nebulisation and pressurised metered dose inhalers (pMDI) with a holding chamber in children with mild to severe asthma exacerbations.

Methods

A two-centre study was conducted during eight months, comparing hospitalisation rates, clinical improvement, side effects, and PED visit length in the overall population and in children under and over 6 years old.

Results

A total of 384 patients were included, primarily with mild and moderate exacerbations of similar severity between groups. The discharge rate was comparable between groups in the overall population (82.7 % without any nebulisation in the pMDI group versus 81.6 %, p = 0.93), but higher for children under 6 years old treated with pMDI (98.1 % versus 76.9 %, p < 0.001). The pMDI group exhibited significantly lower hospitalisation rates (p < 0.001) and shorter PED visits (1.7 [1.2–2.6] hours versus 4.0 [2.6–5.3] hours, p < 0.001) while receiving lower salbutamol doses (0.10 [0.05–0.16] mg/kg versus 0.81 [0.55–1.18] mg/kg, p < 0.001) with less ipratropium and oral corticosteroids (p < 0.001 and p < 0.001). The pMDI group demonstrated fewer side effects, particularly oxygen dependence, especially in children under 6 (p < 0.001).

Conclusion

The study suggests that salbutamol via pMDI with a holding chamber is as effective as nebulisation for treating mild to moderate childhood asthma exacerbations. This approach results in fewer hospitalisations, reduced side effects, and shorter PED visits. Educating patients on pMDI use and efficacy could further decrease emergency visits for asthma exacerbation.