A randomised controlled trial to assess the relative benefits of large volume spacers and nebulisers to treat acute asthma in hospital
a Southampton General
Hospital, Tremona Road, Southampton SO16 6YD, UK, b Southampton University
Medical School, Bassett Crescent East, Southampton SO16 7NW, UK, c Poole General Hospital,
Longfleet Road, Poole, Dorset BH15 2JB, UK
Correspondence to: Dr Connett.
Accepted 12 January
1999
OBJECTIVES
To compare
the clinical effectiveness, acceptability, and cost benefit of
administering 
2 agonists by means of a metered dose
inhaler and large volume spacer with conventional nebulisers to
children admitted to hospital with acute asthma.
METHODSA randomised
controlled trial was conducted over five months. Sixty one children
older than 3 years admitted to a large teaching hospital and a district
general hospital with acute asthma completed the study. Children
received either 5 mg of salbutamol up to one hourly by jet nebuliser,
or up to 10 puffs of salbutamol 100 µg by means of a metered dose
inhaler and spacer up to one hourly.
RESULTSMedian
hospital stay was 40 hours in the nebuliser group and 36.5 hours in the
spacer group. Asthma disability scores at two weeks after discharge
were significantly improved in the spacer group. Drug costs were
£14.62 less for each patient in the spacer group.
CONCLUSIONSLarge
volume spacers are an acceptable, cost effective alternative to
nebulisers in treating children admitted with acute asthma, provided
that the children can use the mouthpiece, and symptoms are not severe.
Their use facilitates effective home treatment by parents, with
subsequent reduction in morbidity and re-admission rates.
Keywords: acute asthma; large volume spacer; metered dose inhaler; nebuliser;
2 agonists;
cost effectiveness
© 1999 by Archives of Disease in Childhood
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