Metered-dose inhaler accessory devices in acute asthma: efficacy and comparison with nebulizers: a literature review.

OBJECTIVES: To evaluate the current literature about the efficacy of providing inhaled medications by metered-dose inhalers and accessory devices (MDI/ADs) to children with acute asthma and to compare it with the current standard of care, small-volume nebulizers (SVNs).

DATA SOURCES: Online computer and manual searches in English-language journal articles published between 1980 and 1996.

STUDY SELECTION: Seventeen prospective clinical trials that have used MDI/ADs in the treatment of acute asthma in children were retrieved. Ten randomized controlled studies that included a comparison with SVN treatment were selected.

DATA EXTRACTION: Studies were assessed qualitatively by their subject characteristics, design, intervention procedures, outcome measures, and results.

DATA SYNTHESIS: There were marked variations in types of MDI/ADs and in doses administered between and within studies. Major outcome measures included pulmonary function measurements and clinical scores. All studies found MDI/ADs to be effective in the treatment of infants and children with acute asthma. Among those who compared this treatment with SVN, 2 found the MDI/AD superior and the rest found it as effective as the SVN.

CONCLUSIONS: The data support the effectiveness of MDI/ADs as first-line treatment in acute childhood asthma. In view of clinical benefit, safety, lower cost, personnel time, and speed and ease of administration of MDI/ADs compared with SVNs, MDI/ADs should be considered the preferred mode of treatment of children with acute asthma.