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You are a UK paediatric trainee working in a small district general hospital in rural Kenya. You see a 4-year-old-boy with asthma, with his third episode of wheeze requiring admission to hospital. He improves with nebulised salbutamol and is ready for discharge home. You suggest a short-acting bronchodilator inhaler, via a water bottle spacer,1 to keep at home, but the parents are unable to afford a metered-dose inhaler (MDI), which is relatively expensive. You have heard of oral salbutamol being sold in nearby pharmacies at lower cost and wonder whether this would be acceptable in this situation. The national paediatric protocol (for Kenya) states that oral salbutamol “should ONLY be used if it is the only option available and for a maximum duration of 1 week”.2
In a child with chronic asthma in a low-resource setting [patient], is oral salbutamol [intervention] an acceptable low-cost alternative to inhaled salbutamol [control] in the reduction in frequency and severity of current or subsequent episodes of wheezing requiring hospitalisation [primary outcome] or the improvement in lung function (PEFR or FEV1) [secondary outcome]?
A literature search was performed; Cochrane, PubMed and Embase were searched in January 2015 with limits of ‘English language’ only, using the following search terms (MeSH in italics): (Albuterol OR salbutamol OR adrenergic beta-Agonists) AND (Administration, oral OR oral medication OR oral) AND (asthma* OR wheeze OR wheezing) AND (Child OR infant OR adolescent OR children OR child, preschool OR pediatric* OR paediatric*). In total, 454, 670 and 806 results from Cochrane, PubMed and Embase, of which …
Contributors DAO’R designed the question, conducted the search, appraised the included papers and wrote the manuscript. AA helped with design of the question and the search and created the case scenario. PC also conducted a secondary search, reviewed and appraised the first draft, and helped with creation of the final draft.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.