Treatment of asthma exacerbations with the human-powered nebuliser: a randomised parallel-group clinical trial

Background: Nebulisers aid the treatment of respiratory diseases, including asthma, but they require electricity and are often cost-prohibitive for low- and middle-income countries. Aims: The aim of this study was to compare a low-cost, human-powered nebuliser compressor with an electric nebuliser compressor for the treatment of mild to moderate asthma exacerbations in adults and children. Methods: This was a non-blinded, parallel-group, equivalence study, with 110 subjects between 6 and 65 years of age, conducted in the emergency department of a district hospital in Ilopango, El Salvador. Participants were assigned by random allocation to receive a 2.5-mg dose of salbutamol from the experimental human-powered nebuliser or the electric nebuliser control. All assigned participants completed treatment and were included in analysis. The study was not blinded as this was clinically unfeasible; however, data analysis was blinded. Results: The mean improvement in peak flow of the experimental and control groups was 37.5 (95% confidence interval (CI) 26.7–48.2) l/min and 38.7 (95% CI, 26.1–51.3) l/min, respectively, with a mean difference of 1.3 (95% CI, −15.1 to 17.7) l/min. The mean improvement in percent-expected peak flow for the experimental and control groups was 12.3% (95% CI, 9.1–15.5%) and 13.8% (95% CI, 9.8–17.9%), respectively, with a mean difference of 1.5% (95% CI, −3.6 to 6.6%). Conclusions: The human-powered nebuliser compressor is equivalent to a standard nebuliser compressor for the treatment of mild-to-moderate asthma. (Funded by the Opus Dean’s Fund, Marquette University College of Engineering; ClinicalTrials.gov NCT01795742.) Asthma: Human-powered nebuliser proves effective A low-cost hand-powered nebuliser is as effective as electrically powered devices for the treatment of mild to moderate asthma. Nebulisers are the most efficient devices for delivering therapy during asthma attacks but the cost of standard electric powered systems and their need for an electricity supply severely limits their use in many low- and middle-income countries. Lars Olson of Marquette University in Milwaukee, and collaborators in the USA and El Salvador, tested a simple nebuliser powered by turning a handle for treating mild to moderate asthma in patients in San Salvador. They found the manual system was equivalent to a standard electric nebuliser for the effective delivery of salbutamol, the most common asthma medication. This innovation could make the well-docum