• Mohammad Fayaz
  • Ambreen Sultan
  • Manzoor Elahi Rai


Background: Due to changing evidence on efficacy of MDI+spacer as compared to nebuliser,two types of managements were going on in our Day unit, depending on the presence of differentmedical professionals. We wanted to find out the evidence of the best practice from within ourunit, and then to formulate guidelines based on it for the management of paediatric acute asthma.Methods: We isolated 54 cases of children suffering from acute asthma attack from admissionsduring Oct 2004–March 2005 within the age range of 3–14 yrs. We categorised them into fourclasses of mild, moderate, severe and life threatening acute attack depending on its severity andthen separated them in two groups. Group I received salbutamol Via MDI+spacer and Group IIreceived salbutamol via nebuliser. Our outcome measure was time to clinical improvement andduration of hospital stay. Results: We didn’t find any major difference between the two groups,moreover MDI+spacer was better than nebuliser for the treatment of severe acute asthma attack inchildren. Conclusion: Our study supported and confirmed the evidence that MDI+spacer is leastas effective as nebuliser in the management of acute asthma in children.Keywords: MDI+spacer, Nebuliser, Juvenile Asthma, Salbutamol, Wheeze


Graham D, Cowley C, Verheul B. Management of acute

asthma in children, NZ Fam Physician 2004;31(3):165–9.

Provisional Committee on Quality Improvement. Practice

Parameter: The office management of acute exacerbation of

asthma in children. Paediatrics 1994;93:119–26.

Hazir T, Das C, Piracha F. Carer’s perception of childhood

asthma and its management in a selected Pakistani

community. Arch Dis Child 2002;87:287–90.

Rao NA, Rizvi N, The efficacy of salbutamol delivered by

inhaler plus spacer device and nebuliser in acute asthma. J

Coll Physicians Surg Pak 2002;12:579–82.

Chong-Neto HG, Chong-Silva DC, Marani DM, Kuroda

F, Olandosky M, Noronha L. Different inhaler devices in

acute asthma attack: a randomised, double blind, placebocontrolled study. J Pediatr (Rio J) 2005;81:274–6.

Lin YZ, Hsiechk KH, Metered dose inhaler and nebuliser in

acute asthma. Arch Dis Child 1995;72:214–8.

Souzer LSF. [Aerosolterpina asma da, erina] J Pediatr (Rio J)


Keelay D. Large volume plastic spacer in asthma should be

used more. BMJ 1992;305:598–9.

Khan MA, Hazir T, Management of bronchial asthma in

children. J Pak Med Assoc 1995;45:46–50.

Amirav I, Newhouse MT. MDI and accessory devices in acute

asthma. Efficacy and comparison with nebuliser: a literature

review, Arch Pediatr Adolesc Med 1997;151:876–82.

The British guidelines on asthma management 1995. Review

and position statement. Thorax 1997;52:S1–S21.

Rachelfsky G. Treating exacerbation of asthma in children, Role

of systemic corticosteroids. Paediatrics 2003;112(2):382–97.

Shah S, Johnson DW, Stephens D. Comparison of Albluterol

delivered by MDI with spacer vs. a nebuliser in children with

mild acute asthma. J Pediatr 1999;135:28–7.

Dompelin E, Oudeslys-Murphy AM. Randomised controlled

study of clinical efficacy of spacer therapy in asthma with

regard to electrostatic charge. Arch Dis Child 2001;84:178–82.

Battistini A, Pisi G, Response to bronchodilator administered

directly with spray or with spacer. Pediatr Med Chir


Castro, Rodriguez JA, Rodrigo GJ, Beta agonists through

MDI with valved holding chamber versus nebuliser for acute

exacerbation of wheezing or asthma in children under 5 yrs

of age: A systematic review of meta analysis. J Pediatr


Delgado A, Chou KJ, Johnson Silver E, Nebulizer vs MDI

with spacer for bronchodilator therapy to treat wheezing in

children aged 2–24 months in paediatric emergency

department. Arch Pediatr Adolesc Med 2003;157(1):76–80.

Rees J, Price J [ABC of asthma] Asthma in children:

treatment. Br Med J 1995;310:1522–7.



Most read articles by the same author(s)