Study objective: Nebulizer systems used to generate therapeutic aerosols vary in their ability to deliver medication to the airway. In a recent study in 17 adults with stable asthma, albuterol given using an ultrasonic nebulizer (UN) appeared to produce greater bronchodilatation than the same dose of albuterol given by a jet nebulizer (JN). The purpose of this study was to determine if the UN used in that study would produce a better bronchodilator response in children with acute asthma than the JN system that has been in use at Cardinal Glennon Children's Hospital.
Design: Randomized, prospective, unblinded study.
Setting: An urban university children's hospital emergency department.
Participants: One hundred thirteen children, aged 7 to 16 years, who presented for treatment of acute moderately severe asthma completed this study.
Interventions: After randomization and exclusion of dropouts, 46 children received albuterol by UN and 67 were treated by JN.
Measurements: Pulmonary function tests (PFTs) by spirometry, pulse oximetry, and symptom score at baseline and at 15 and 30 min following a single prescribed treatment.
Results: PFT on entry to the study was the same in both groups (FEV1; p>0.97). The change in FEV1 after therapy (UN+0.22 L vs JN+0.37 L) was significant (p<0.05) and favored JN. There was no difference in the improvement in pulmonary function between JN and UN therapy in children with an initial FEV1/FVC>75% predicted but when FEV1/FVC<75%, the improvement in FEV1 again favored the JN (UN+0.2 vs JN+0.47; p<0.05).
Conclusion: For the treatment of acute exacerbations of asthma in children, there is no greater bronchodilator response when albuterol is administered by a UN than by a JN.