Broncho dilator response to salbutamol delivered by metered dose inhaler with spacer versus dry powder inhaler in acute asthma in children

Background: Different asthma drug delivery systems have been developed for children, each having its own advantages and disadvantages. Limited number of studies exist to compare their clinical efficacy. Aims: To compare the efficacy of metered dose inhaler (MDI) with spacer and dry powder inhaler (DPI) in delivering salbutamol in children with mild or moderate acute asthma. Methods: Randomized controlled study included 206 Children of 6-15 years having mild or moderate acute asthma and distributed randomly into two equal groups to receive 400micro-gram of salbutamol delivered by either a MDI with spacer or a DPI device. The primary outcome variable was peak expiratory flow rate (PEFR) and secondary outcome variables were heart rate, respiratory rate, oxygen saturation, wheezing and accessory muscle scores. Changes in primary and secondary outcome variables, before and 30 min after salbutamol inhalation, were recorded and subjected to statistical tests for significance. Results: Changes in primary outcome variable (PEFR) in both groups before and after drug intervention were 179.19 ± 33.27 vs. 197.52 ± 57.01 liters/min and 184.81 ± 59.65 vs. 202.83 ± 64.76 liters/min respectively, which was statistically highly significant (P= 0.001). Similar significant changes were also observed in case of secondary outcome variables. Conclusion: Bronchodilator response to salbutamol in mild or moderate acute asthma in children is similar when equal amount of drug is delivered either through an MDI with spacer or a DPI.