Efficacy of metered-dose inhalers for children with acute asthma exacerbations

Objective To compare the effectiveness of the administration of inhaled beta‐agonists delivered via a metered‐dose inhaler (MDI) with spacers—as part of an evidence‐based asthma pathway developed to manage acute asthma exacerbations in children at the emergency room level and in inpatient management—against administration via nebulization. Design Case with historical control. Setting KK Women's and Children's Hospital (Singapore). Participants A total of 19,951 children (infants to older children) aged 18 years and younger who attended the emergency room for asthma exacerbations. Main Outcome Measures Average length of stay, proportion admitted to high dependency or intensive care, proportion readmitted for unresolved symptoms within 72 hr, cost per patient and overall. Results There was no increase in the mean proportion of emergency room attendances admitted to inpatient care with use of an MDI (mean difference 0.97%, 95% CI: −1.6–3.5%, P = 0.447), nor of children admitted to intensive care (0.21 vs. 0.20 pre‐ and post‐pathway, P = 0.827) or to high dependency units (2.21 vs. 1.37 pre‐ and post‐pathway, P = 0.200) but a significant reduction in the within 72 hr re‐attendance rate (mean difference 1.4%, 95% CI: 0.78–2.0%, P