Different inhaler devices in acute asthma attacks: a randomized, double-blind, placebo-controlled study

Abstract

Objective: To verify the efficacy, side effects, and cost of treatment of acute asthma attacks, using different inhaler devices.Methods: This is a randomized, double-blind, placebo-controlled study. Salbutamol was administered via a nebulizer, a metered-dose inhaler (attached to a commercially available spacer device), a homemade non-valved spacer device, or a dry powder inhaler. Assessments were made at zero, 20, 40 and 60 minutes, followed by the application of salbutamol and placebo with another device. Forty children (mean age of 11±3.5 years) with acute asthma attacks, were evaluated. Clinical score, forced expiratory volume in one second and side effects were analyzed. The costs for medication and spacer devices were calculated.Results: There is no difference between groups regarding clinical score and variation of forced expiratory volume in one second. There was a major variation in the heart rate response to the nebulizer (35%) compared to the commercially available spacer and dry powder inhaler (15 and 17%) and between the homemade spacer and the commercially available spacer (28 and 15%) (p = 0.004). The nebulizer and homemade spacer caused more tremor (p = 0.02). The cost of treatment was higher for the nebulizer and commercially available spacer (p = 0.0001). Conclusions:The nebulizer was more expensive and used more medicine, showing the same efficiency. The homemade spacer was cheaper, but presented more side effects. The commercially available spacer was as expensive as the nebulizer, although safer. The dry powder inhaler was cheaper, but, just as the homemade spacer, it also caused tachycardia.J Pediatr (Rio J). 2005;81(4):298-304: Nebulizers, metered-dose inhalers, inhalation spacers, homemade spacer, child.

Systematic review: Insufficient validation of clinical scores for the assessment of acute dyspnoea in wheezing children

“…AS Asthma score; [13] ASS asthma severity score; [14][15][16][17][18][19] BS bronchiolitis score (original names: BS-2 respiratory scale; BS-3 clinical scoring; BS-4 severity score); [20][21][22][23] CAES clinical asthma evaluation score (original names: CAES-2 clinical severity score or modified clinical asthma score; CAES-3 modified clinical asthma score); [24][25][26][27] CAS clinical asthma score [28]; CS clinical score [29]; CSGS clinical symptom grading system; [30,31] CSS clinical scoring system (original names: CSS-2 modified Tal's clinical score; CSS-4 clinical score); [6,[32][33][34][35][36][37][38][39][40][41] EDRAR escala de diffcultad respiratoria de la Argentina; [42] EDRCH escala de dificultad respiratoria de Chile;41 MPIS modified pulmonary index score; [43] PASS pediatric asthma severity score; [44,45] PRAM paediatric or preschool respiratory assessment measure; [45][46][47] PIS pulmonary index score; [48][49][50][51][52][53]…”

Perfil epidemiológico de hospitalizações por asma no Estado de Roraima: análise de dados do Departamento de Informática do Sistema Único de Saúde (DATASUS)

“…Contudo, a asma trata-se de uma doença inflamatória complexa e multifatorial, cujas manifestações são bastante heterogêneas. Nenhum gene específico foi associado à asma, embora evidências demonstrem consideráveis número de polimorfismos que estão relacionados ao funcionamento da barreira epitelial, bem como aos processos de estresse oxidativo, à inflamação e também às interações epigenéticas (Chong-Neto et al, 2005;Ding et al, 2015).…”