Nisar Ahmed Rao, Nadeem Rizvi.
The efficacy of Salbutamol delivered by inhaler plus spacer device and nebulizer in acute asthma: A comparative study.
J Coll Physicians Surg Pak Jan ;12(10):579-82.

Objective: To evaluate the efficacy of bronchodilator inhalers (salbutamol) delivered through holding chamber (spacer) and to compare it with nebulizer therapy, in patients suffering from acute asthma. Design: Prospective, randomized, double blind, placebo controlled study. Place and Duration of Study: This study was conducted at Emergency Departments of Civil Hospital, Karachi and Jinnah postgraduate medical centre, Karachi between November, 1998 and March, 1999. Subjects and Methods: This study was done in 50 asthmatic patients presented with an acute attack. Patients were randomly assigned to receive either salbutamol by nebulizer plus placebo by metered dose inhaler (MDI) with spacer (n = 25) or salbutamol by metered-dose inhaler with spacer plus placebo by nebulizer (n = 25). The dose was repeated every 30 minutes until patient clinically improved or forced expiratory volume in one second (FEV1) improved to 70% of predicted or 3 doses have been given. Results: The base line forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR) and forced vital capacity (FVC) showed no significant difference (P > 0.43) between the two groups. In both groups, significant improvement occurred in mean FEV1, after first treatment at 30 min (P < 0.03). Further improvement noted after second treatment but it was slight and statistically insignificant (P < 0.68). In both groups, improvement was also noted in PEFR, FVC, pulse and respiratory rate. However, no significant differences occurred between both groups in mean pulse, respiratory rate, FEV1, PEFR and FVC after first and second treatment. Forty-nine out of fifty patients improved with the study protocol and were discharged. While one patient from nebulizer group deteriorated and shifted to intensive care. Conclusion: Salbutamol administered by metered-dose inhaler with spacer is effective and there was no detectable difference in efficacy when the same was compared with nebulizer.

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