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Metered-dose inhalers underused in pediatric asthma emergencies

מתוך medicontext.co.il
By David Douglas

NEW YORK (Reuters Health) – Regardless of the efficacy of metered-dose inhalers (MDIs) in treating children with acute asthma exacerbations, most emergency department physicians continue to favor nebulizers, according to a survey conducted by researchers at Boston University School of Medicine.

This is the case, lead researcher Dr. Irene Tien told Reuters Health, "despite the evidence in the literature demonstrating that they are as clinically efficacious as nebulizers and result in fewer side effects when used to deliver bronchodilators."

Dr. Tien and colleagues analyzed survey responses from 333 physicians most of whom were trained in pediatrics and pediatric emergency medicine and worked full-time in urban pediatric emergency departments.

As reported in the December issue of the Archives of Pediatrics and Adolescent Medicine, MDIs were used in the emergency department by no more than 21% of respondents and were reserved for mild exacerbations. At least 58% always used a nebulizer, and 22% based their choice on the severity of the exacerbation.

Among other cited factors for MDI use were ability of the child to cooperate and standard emergency department practice. Furthermore, despite the availability of valved spacers which essentially obviate breath timing problems, 16% felt that MDIs were too difficult to use in the very young.

Despite reluctance to use MDIs when children were uncooperative, the investigators point out that use of an MDI and spacer in an uncooperative child might take 3 minutes, compared to as long as 15 minutes when a nebulizer is employed.

Although many emergency department physicians are familiar with the benefits of MDI use, the researchers conclude "a majority do not use them."

In light of the clinical and other advantages of MDIs "such as portability, cost, and reinforcement of patient and parent faith in MDIs," Dr. Tien added, "physicians should strongly consider incorporating MDIs into their clinical practice."

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