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Spacers were better and less expensive than nebulisers for giving albuterol to children with moderate to severe acute asthma

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 QUESTION: In young children seen in the emergency department for moderate and severe acute asthma, is delivery of albuterol by metered dose inhaler (MDI) and spacer a cost effective alternative to delivery by nebuliser?

Design

Randomised (allocation concealed*), blinded {patients, clinicians, and outcome assessors},* controlled trial with 48 hour follow up.

Setting

A children's hospital in Auckland, New Zealand.

Patients

60 children who were 1 to 4 years of age (mean age 34 mo, 64% boys), had a known history of asthma, and presented to the emergency department with an acute exacerbation of asthma that was rated as moderate to severe. Exclusion criteria were inhaled bronchodilator use in the hour before presentation, immediate admission to the intensive care unit, or a co-existing medical condition, such as pneumonia. Follow up was complete.

Intervention

Children were allocated to albuterol, 600 μg by …

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