Randomized Controlled Trial of a Breath-Actuated Nebulizer in Pediatric Asthma Patients in the Emergency Department

Author : P. Ward

Publication Source: Respir Care 2011;56(6):761–770.

BACKGROUND: Bronchodilator treatment for asthma can be provided with various aerosolgenerating
devices and methods. There have been no randomized trials of a breath-actuated nebulizer
versus continuous 1-hour nebulization and/or small-volume constant-output nebulizer in
pediatric asthma patients. METHODS: We conducted a randomized study of one-time albuterol
treatment with the AeroEclipse breath-actuated nebulizer versus standard therapy (single treatment
via small-volume nebulizer or 1-hour of continuous nebulized albuterol) in pediatric asthma
patients in the emergency department. Eligible patients were those admitted to the emergency
department, 0 months to 18 years of age, who presented with asthma or wheezing. We assessed all
the patients with our clinical asthma scoring system and peak-flow measurement if possible. We
stratified the patients by clinical asthma score and weight, and then randomized them to receive
their initial albuterol treatment in the emergency department via either AeroEclipse or standard
therapy. We recorded time in the emergency department, change in clinical asthma score, need for
additional bronchodilator treatments, need for admission, patient response, ability to actuate the
AeroEclipse, and adverse effects. RESULTS: We enrolled 149 patients between October 14, 2004
and November 11, 2005, and we randomized 84 patients to AeroEclipse and 65 to standard therapy.
The cohort’s average age was 5.5 years. There were no significant differences in demographics. The
initial mean clinical asthma scores were 5.1  2.4 in the AeroEclipse group, and 5.1  2.1 in the
standard-therapy group. Time in the emergency department was not different (AeroEclipse 102 min,
standard therapy 125 min, P  .10), but the AeroEclipse group had a significantly greater improvement
in clinical asthma score (1.9  1.2 vs 1.2  1.4, P  .001) and respiratory rate (P  .002),
and significantly lower admission rate (38% vs 57%, P  .03). There was no difference in adverse
effects. CONCLUSIONS: Although AeroEclipse did not reduce the time in the ED, it significantly
improved clinical asthma score, decreased admissions, and decreased respiratory rate. Key words:
asthma; bronchodilator; aerosol; nebulizer; breath-actuated; pediatric; albuterol; emergency; department;
clinical asthma score.