Comparison between the bronchodilator response to albuterol administered with valved and non-valved spacers in pediatric asthmatic patients
Comparación entre la respuesta broncodilatadora al inhalador de salbutamol, administrado con espaciadores con válvulas y con espaciadores sin válvulas, en pacientes pediátricos asmáticos
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Introduction: Inhaled therapy using a metered-dose inhaler (MDI) with attached valved holding chamber has been increasingly recognized as the optimal method for delivering bronchodilators for asthma treatment. However, mainly due to the high cost of these valved holding chambers, in Colombia the use of spacers without valves is frequent, despite the scarce evidence that supports its effectiveness.
Objective: The aim of this study was to compare the bronchodilator response to albuterol administered by MDI with a valved holding chamber versus a commercially produced non-valved spacer.
Design: A randomized, two-period, two-sequence crossover trial.
Patients and methods: 31 patients were studied on two separate test days, and were randomly assigned to receive 100 and 400 mcg of salbutamol MDI either through a valved holding chamber or a non-valved spacer. Thereupon, crossover treatment was employed by the use of the alternative spacer in the same way. Spirometry was recorded before and after salbutamol administration. We evaluated sequence and period effects before testing for any treatment effect, using Student´s t test for independent samples, or the Mann-Whitney U test, as appropriate.
Results: Since we identified no notable sequence or period effects, we tested for treatment effects in both periods. When patients received 100mcg of salbutamol, we found no statistically significant treatment differences in VEF1 (t=-0.42, p=0.68), CVF (t=-1.30, p=0.24) or MMEF (t=1.47, p=0.18). Likewise, when patients received 400mcg of salbutamol, we found no statistically significant treatment differences in VEF1 (t=-0.06, p=0.95), CVF (t=-1.28, p=0.24) or MMEF (t=1.16, p=0.28).
Conclusions: The use of a valved spacer showed no advantage over the use of a non-valved spacer with respect to the bronchodilator response at different dosages of albuterol in stable asthmatic pediatric patients.
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