Abstract

IntroductionIn moderate-severe asthma exacerbation, salbutamol by inhaler (MDI) is superior to salbutamol delivered by nebulizer (NEB); however, to our knowledge, no studies in children with exclusively severe exacerbations were performed. ObjectiveTo compare the efficacy of salbutamol and ipratropium bromide by MDI versus by NEB in severe asthma exacerbations. MethodsWe performed a clinical trial enrolling 103 children (2-14 years of age) with severe asthma exacerbations (defined by the Pulmonary Score7) seen at the emergency room in Asuncion, Paraguay. One group received salbutamol and ipratropium (two puff every 10min for 2h and then every 30min for 2h more) by MDI with a valved-holding chamber and mask along with oxygen by a cannula separately (MDI-SIB); and the other received nebulization with oxygen (NEB-SIB) of salbutamol and ipratropium (1 every 20min for 2h and then every 30min for 2h more). Primary outcome was the rate of hospitalization (Pulmonary Score7) after 4h and secondary outcome was oxygen saturation. ResultsFifty two children received MDI-SIB and 51 NEB-SIB. After the 4th hour, children on MDI-SIB had significantly (P=0.003) lower rate of hospital admission than on NEB-SIB (5.8% vs 27.5%, RR: 0.21 [0.06-0.69], respectively). Similarly, a significant improved clinical score after 60min and increase in oxygen saturation after 90min of treatment was observed in MDI-SIB versus NEB-SIB group (4.460.7 vs 5.76 +/- 0.65, P<0.00001; and 90.5 +/- 1.7 vs 88.43 1 +/- 1, P<0.00001, respectively). ConclusionEven in severe asthma exacerbations administration of salbutamol and ipratropium by MDI with valved-holding chamber and mask along with oxygen by a cannula separately was more effective than by a nebulizer.