|Year : 2021 | Volume
| Issue : 4 | Page : 171-172
Acute exacerbation of bronchial asthma in children-is jet nebulizer superior?
Department of Pediatrics and Intensive Care, INHS Asvini, Colaba, Mumbai, Maharashtra, India
|Date of Submission||14-Jun-2021|
|Date of Acceptance||17-Jun-2021|
|Date of Web Publication||10-Jul-2021|
Dr. Bal Mukund
Department of Pediatrics and Intensive Care, INHS Kalyani, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mukund B. Acute exacerbation of bronchial asthma in children-is jet nebulizer superior?. J Pediatr Crit Care 2021;8:171-2
Acute exacerbation of bronchial asthma in children is one of the most common reasons for an emergency visit and hospitalization. Exacerbations are episodes with increase in symptoms of shortness of breath, chest tightness or wheezing and progressive decrease in lung functions. Severe exacerbations are potentially life-threatening hence treatment requires careful evaluation and further assessment of severity and close monitoring.
Mild exacerbation is treated in a home-based or primary care settings depending upon expertise and resources. It is moderate to severe exacerbations which require close monitoring and admission in a Pediatric Intensive Care Unit. In this subset of children, treatment with short-acting γ2 agonists (SABA), controlled oxygen, and systemic corticosteroids should be initiated while arranging for the patient's urgent transfer to an acute care facility for further management. Delivery of SABA through a metered-dose inhaler (MDI) and spacer or a dry powder inhaler leads to a similar improvement in lung functions as delivery of SABA through a nebulizer., However, its pertinent to note that in these studies acute severe asthma was not included. The most cost-effective method of SABA administration is pMDI and spacer.
In this issue of Journal of Pediatric Critical Care, Batra et al. published a randomized trial between MDI and spacer with jet nebulization in acute asthma in children aged 5–14 years presenting to the emergency department. They randomly assigned 100 children with inclusion criteria to either MDI with a spacer or jet nebulization as per protocol. They monitored vital parameters, use of accessory muscles, peak expiratory flow rate, and venous blood gas analysis for PaCO2 and requirement of admission and length of stay. There was a significant difference in change of respiratory rate at 20 min in jet nebulization group, but not subsequently. Similarly greater change in heart rate was observed in nebulization group than MDI at all observation time points. There was no significant differences in other parameters such as accessory muscle use, venous blood gas parameters, changes in peak expiratory flow rate, or any adverse events. There was no differences observed even for different severity sub-groups among all enrolled patients. The admission rate and stay in the emergency department for >6 h were also similar. Similar observations were found by Jamalvi et al., Dhuper et al., and Batra et al. for similar enrolled group as mentioned by authors. It is important to mention that had this study included a better technique of sampling, objective score like clinical asthma severity score a comprehensive objective tool for different gradation of severity and their response, results would have been more desirable. A larger multi-centric study is required which is statistically powered to measure any difference in response to different clinical and laboratory parameters in acute asthma in children before a final conclusion can be drawn.
| References|| |
Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, et al
. An official American Thoracic Society/European Respiratory Society statement: Asthma control and exacerbations: Standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009;180:59-99.
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention; 2019. Available from: http://www.ginasthma.org. [Last assessed on 2021 May 02].
Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2013:CD000052.
Selroos O. Dry-powder inhalers in acute asthma. Ther Deliv 2014;5:69-81.
Batra R, Mittak K, Khanna A. Comparison of effectiveness of metered dose inhaler with spacer and jet nebulizer in children aged 5-14 years with acute asthma - Randomized controlled trial. J Pediatr Crit Care 2021;8:177-81. [Full text]