Randomised controlled trial of the efficacy of a metered dose inhaler with bottle spacer for bronchodilator therapy in acute lower airways obstruction

Heather Zar ^1*, Susanne Streun ², Michael Levin ², Eugene Weinberg ² and George Swingler ²

¹ University of Cape Town
² School of Child and Adolescent Health, Red Cross Children's Hospital, University of Cape Town

^* To whom correspondence should be addressed. E-mail: hzar{at}ich.uct.ac.za.

Accepted 1 August 2006

Abstract

Background: Inhaled bronchodilator therapy given via a metered dose inhaler (MDI) and spacer is optimal for relief of bronchoconstriction. Conventional spacers are expensive or unavailable in developing countries but there is little information on the efficacy of low cost spacers in young children.

Objective: To compare the response to bronchodilator therapy given via a conventional or low cost bottle spacer.

Methods: A randomised controlled trial of the efficacy of a conventional compared with a bottle spacer for bronchodilator therapy in young children with acute lower airways obstruction. Bronchodilator therapy was given from a MDI via an Aerochamber or a bottle spacer. A clinical score and oximetry recording were done prior and 15 minutes after therapy. MDI-spacer therapy was repeated up to 3 times, dependent on clinical response, after which nebulisation was used. The primary outcome was hospitalization.

Results: Four hundred children, aged [median (25th-75th percentile)] 12 (6-25) months, were enrolled. The number hospitalized (60, 15%) was identical in the conventional and bottle spacer groups (30, 15% in each). Secondary outcomes including change in clinical score [- 2 (-3 to -1)], oxygen saturation [0 (-1 to 1)] and number of bronchodilator treatments [2 (1 to 3)] were similar in both groups. Oral corticosteroids, prescribed for 78 (19.5%) children, were given to a similar number in the conventional [37 (18.5%)] and bottle spacer groups [41 (20.5%)].

Conclusion: A low cost bottle spacer is as effective as a conventional spacer for bronchodilator therapy in young children with acute lower airways obstruction.

Keywords: airways obstruction, bottle, child, spacer

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