Bronchodilator effect of fenoterol and ipratropium bromide in infants with acute wheezing: Use of MDI with a spacer device

Abstract

Twenty-eight infants admitted to Exequiel González Cortes Children's Hospital because of acute wheezing (AW) were randomly assigned to three study groups. Fenoterol (FNT), ipratropium bromide (IB), and placebo were administered respectively to children in the different groups by means of metered dose inhalers (MDI) with spacers, using doses of 3 puffs every hour, for 4 hours. The degree of bronchial obstruction was assessed clinically and scored with the single-blind method every hour prior to each treatment. The criterion of a bronchodilator effect was a significant decrease in the degree of bronchial obstruction at subsequent scorings. The scores of the three groups were compared using the Student's t test for matched samples. The same test was also applied to the independent samples for determining the superiority of one treatment, FNT or IB, over the other. The results indicated a significant decrease in the scores of the groups receiving FNT and IB (P less than 0.05); this did not occur in the group in which placebo was used. FNT produced a more rapid and sustained effect than IB (P less than 0.05). Significant bronchodilator effect was obtained in infants with AW when repeated doses of FNT or IB were administered with MDI and spacers. This effect was significantly greater in the group treated with FNT.

Efficacy of bronchodilators administered by nebulizers versus spacer devices in infants with acute wheezing

“…[11][12][13][14][15][16][17][18] It has also been reported that bronchodilator drugs can be inhaled passively through spacer devices in infants, 17 with widespread deposition into the lower airways. There have been some good results in the administration of anti-cholinergic drugs [19][20][21] and beta-2 agonists [22][23][24][25][26] with MDI-spacer devices in infants and young children. Noting that no studies have been done comparing these two methods of bronchodilator delivery in young children and infants with acute wheezing, we decided to conduct a double-blind, randomized study to compare the response to inhaled terbutaline delivered with a nebulizer to that delivered with an MDI-spacer device.…”

Efecto broncodilatador de fenoterol y salbutamol asociados a un corticoide en niños con crisis de asma.

“…Dos de los fármacos más usados son el salbutamol y el fenoterol. La ruta de administración que se prefiere para los beta-2 agonistas es la vía inhalatoria (5,17,26,27) ya que esta maximiza la cantidad de droga aplicada a la vía aérea y minimiza los efectos colaterales. Una forma de administración adecuada es por medio de un microdosificador inhalatorio (MDI) (8,28) que ha demostrado ser tan o más eficaz que el nebulizador (29) ya que con el MDI se obtiene igual efecto broncodilatador con una menor dosis (28).…”

“…El inconveniente con el MDI sobre todo en niños pequeños es la falta de coordinación entre el momento del disparo del MDI y la inspiración profunda entre el momento del disparo del MDI y la inspiración profunda necesaria para que el medicamento llegue en forma adecuada a nivel bronquial (15). Esto puede ser superado con el uso de una aerocámara (5), con lo que según técnicas ya establecidas (8,5,17,18), se mejora la dosis efectiva en pulmones (30).…”

“…aprox. 900 cc), donde por un lado esté la cara del paciente y por el otro se aplique el MDI (5,(17)(18)(19). Al accionar el MDI se indicó el paciente que inhale dentro de la aerocámara en forma lenta y profunda (8,20) por ocho veces.…”

Randomized trial of salbutamol via metered-dose inhaler with spacer versus nebulizer for acute wheezing in children less than 2 years of age

“…In addition, wheezing illnesses together with pneumonia are the leading cause of hospitalization for children in Chile. 2 Previous studies using a clinical score have demonstrated the utility of beta-2-agonists administered by metered-dose inhaler (MDI) with a spacer and a face mask in the treatment of acute exacerbations of wheezing in infants 3,4 and children. 5 Furthermore, studies in adults 6 and children over 2 years of age [7][8][9][10][11] have shown that beta-2-agonists administered by MDI with a spacer device and a face mask are as effective as nebulization in the treatment of asthma or acute exacerbations of wheezing and result in fewer adverse effects (tachycardia, vomiting, and oxygen desaturation) than when salbutamol is delivered by nebulizer.…”