Metered-Dose Inhaler Accessory Devices in Acute Asthma

Amirav, Israel

doi:10.1001/archpedi.1997.02170460014003

Cited by 75 publications

(9 citation statements)

References 50 publications

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“…The results of this first systematic review in almost 500 infants or children under 5 years of age with acute wheezing or asthma exacerbation are in agreement with systematic reviews performed in adults and older children with asthma exacerbation who visit the ED. 5,9,46 In our meta-analysis, we also looked at secondary outcomes of side effects (heart rate, respiratory rate, or oxygen saturation) that sometimes occur with b-agonist administration through different systems (eg, MDI+VHC or nebulizer). However, this was difficult to analyze because of insufficient data.…”

Section: Discussionmentioning

confidence: 99%

β-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: A systematic review with meta-analysis

Castro-Rodriguez¹,

Rodrigo²

2004

The Journal of Pediatrics

169

105

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Section: Discussionmentioning

confidence: 99%

β-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: A systematic review with meta-analysis

Castro-Rodriguez¹,

Rodrigo²

2004

The Journal of Pediatrics

169

105

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“…[1][2][3][4][5][6][7][8][9][10] As early as 1997, a review of 10 randomized, controlled trials involving 575 pediatric patients recommended that MDIs with holding chambers be considered the preferred mode of treatment in children with acute asthma.…”

Section: Ré Sumémentioning

confidence: 99%

“…The secondary objective was to retrospectively document the components of the intervention and their timing. Quieter Reduced cost for medication and medical devices 3,6,7,10,36 Reduced morbidity 5,6 Reduced risk of cross-infection 11,37 Reduced staffing costs 12,36 Reduced administration time 1,3,4,6,10 Reduced time in department 3,4 Reduced morbidity/potentially reduced admissions 6,7 Reduced time and risk in maintenance of the nebulizer system in the community setting 6,10 Valuable opportunity for teaching and reinforcement 3,6,11 Increased staff satisfaction…”

Section: Ré Sumémentioning

confidence: 99%

Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department

Hill-Taylor

Hurley

Sketris

et al. 2013

CJEM

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Objective: The primary objective of this study was to quantify the impact of a clinical practice intervention to promote the delivery of salbutamol by metered-dose inhaler (MDI) in a pediatric emergency department (PED). A secondary objective was to retrospectively document the components of the intervention. Methods: PED inventory data for salbutamol inhalation solution (nebules), MDIs, and holding chambers were obtained from the pharmacy department. Patient data were obtained from the hospital's decision support unit. Interrupted time series analysis was used to evaluate trends in salbutamol inventory data, patient triage acuity, and hospital admissions from January 1, 2003, to May 31, 2010. Interviews and administrative documents were used to identify components of the intervention, which began in 2006.Results: There was a 1,215% increase in the proportion of salbutamol delivered as MDIs compared to total inhaled salbutamol (MDI plus nebulization solution) following the intervention (95% CI 1,032% to 1,396%, p , 0.001). Increases in salbutamol MDI use were associated with the implementation of an institution-specific asthma care map. A relative decrease of 32% in the hospital admission rate (absolute 27.25%: 95% CI 28.31 to 26.19, p , 0.001) was associated with the change in salbutamol MDI use and the use of the asthma care map. Conclusions: A multifaceted intervention, designed and implemented by local PED clinical leaders, resulted in a pronounced change in salbutamol inhalation practice, with an associated decrease in admission rates. This intervention demonstrated many of the criteria for successful health system change. Findings from this research may be contextualized to inform change elsewhere. RÉ SUMÉObjectif: L'é tude avait pour objectif principal de quantifier l'incidence d'une intervention clinique visant à promouvoir l'administration de salbutamol au moyen d'un aé rosoldoseur (AD) dans un service d'urgences pé diatriques (SUP) hautement spé cialisé . Mé thode: Les donné es sur le nombre de né bules de salbutamol en solution pour inhalation, d'AD, et de chambres d'inhalation au SUP ont é té obtenues du service de pharmacie. Les donné es sur les patients, elles, ont é té obtenues du service d'aide à la dé cision de l'hô pital. Nous avons eu recours à l'analyse de sé ries temporelles interrompues pour é valuer les tendances observé es dans les donné es sur la quantité de salbutamol, la gravité de l'é tat des patients au moment du triage, et les hospitalisations, du 1er janvier 2003 au 31 mai 2010. Des entrevues et des documents administratifs ont servi à la dé termination des composants de l'intervention, qui a commencé en 2006. Ré sultats: Une augmentation de 1,215 % de la proportion de salbutamol administré au moyen d'un AD comparativement à la quantité totale de salbutamol administré en inhalation (AD plus solution pour né bulisation) a é té relevé e à la suite de l'intervention (IC à 95 % 1,032 % à 1,396 %; p , 0.001). L'augmentation de l'utilisation du salbutamol en AD a é té associé e à...

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“…The development of VHCs has greatly improved the efficacy of MDIs for young children by creating a reservoir of aerosol that can be inhaled for 3 to 5 seconds after actuation, eliminating the need for hand-breath coordination and for slow, deep inhalation. 13 An alternative to the MDI is the small-volume nebulizer (SVN). Advantages to SVNs include use at any age, administration while asleep, use of oxygen or helium plus oxygen as driving gas, and variable drug combination (b-agonist, anticholinergic, epinephrine, inhaled corticosteroid).…”

Section: Delivery Systemsmentioning

confidence: 99%