To compare the efficacy of an improvised cardboard cone with a conventional spacer (NebuChamber, AstraZeneca) for the delivery of inhaled bronchodilator for children with acute asthma.
Sixty-two patients, aged 5 to 17 years with acute exacerbation of bronchial asthma, seen at the Children’s Asthma Unit and Pediatric Out-Patient Department in the University of Santo Tomas Hospital were included in the study. A single-blind (investigator blind) randomized controlled trial was conducted for 7 months. Terbutaline was given by the co-investigator via metered-dose inhaler (MDI) using either of the randomly assigned NebuChamber or cardboard cone constructed from pharmaceutical flyers. History was taken and clinical assessment before and 15 minutes after use of the MDI-spacer was done by the primary investigator using the following parameters: (1)respiratory rate; (2)accessory muscles and suprasternal retractions; (3)wheeze; and (4)peak expiratory flow (PEF). The primary investigator was unaware as to the type of spacer used.
Patients who used the NebuChamber and cone with MILD exacerbation showed statistically significant differences in respiratory rate (NebuChamber p=0.004, cone p=0.019), wheeze (NebuChamber p=0.001, cone p=0.002) and PEF (NebuChamber p=0.000, cone p=0.000) between pre and post-bronchodilator. With regard to the use of accessory muscles and suprasternal retractions, there was no statistically significant difference between pre and post-bronchodilator (NebuChamber p=1.000, cone p=1.000). Among those who used the NebuChamber and cone with MODERATE exacerbation, there were likewise statistically significant differences in respiratory rate (NebuChamber p=0.013, cone p=0.000), wheeze (NebuChamber p=0.000, cone p=0.000) and PEF (NebuChamber p=0.000, cone p=0.000) between pre and post-bronchodilator. However, there was no statistically significant difference in the use of accessory muscles and suprasternal retractions between pre and post-bronchodilator (NebuChamber p=0.317, cone p=0.180).
There was significant improvement in the lung findings and PEF of patients who used both the NebuChamber and coardboard cone. The cardboard cone, as an improvised spacer, is comparable with the NebuChamber.
The improvised cardboard cone can be used as an inexpensive alternative spacer particularly in developing countries.
J.J. Quetulio, None.