Comparison of Salbutamol Delivered Via Jet Nebulizer With A Metered Dose Inhaler (MDI) Plus A Spacer for Asthma Exacerbation of Children: A Randomized Clinical Trial


Asthma is the most common chronic illness in children and is a major reason for pediatric
emergency department visits. Beta-2 agonists are considered the most effective drugs for immediate relief in
the symptoms. This study aimed to compare the effectiveness of salbutamol delivered via jet nebulizer with a
metered-dose inhaler (MDI) plus a spacer for asthma exacerbation in the pediatric emergency departments. The
study was a randomized control, parallel-group design in children with age ranging from 6 months to 14 years,
presenting in the emergency department with an acute asthma attack. A total of 116 patients were recruited for
the study. Sixty-two patients were enrolled in the MDI/spacer group, and 54 patients were in the nebulizer
group. Patients were assessed at baseline (0 min) and 15, 30, 45 and 60 min after commencement of the
nebulizer and MDI/spacer. The response of each group to treatment was compared. The parents were counseled for their child enrolment in the study, which was approved by the Human Ethics Committee of Shahid Beheshti
University of Medical Sciences. Ethic code was IR.SBMU.SM.REC.1394.19. The patients in both treatment
groups demonstrated statistically noticeable improvement in clinical scores at all study assessment periods.
Results revealed that salbutamol via MDI/spacer was as effective as salbutamol nebulization during the
treatment of asthma exacerbations. Salbutamol MDI/spacer is equally efficacious when compared to
nebulization. Therefore, because Salbutamol MDI/spacer is more user-friendly and affordable, it is preferable
to be used in emergency departments

1. Sullivan PW, Ghushchyan V, Navaratnam P, Friedman HS, Kavati A, Ortiz B, et al. The national burden of poorly controlled asthma, school absence and parental work loss among school-aged children in the United States. Journal of Asthma. 2017:1-9.
2. Sae-Hoon Kim K-HS, Sung-Yoon Kang, Jung-Hyun Kim, Ji-Won Kwon, Jung-Im Na, Byung-Keun Kim, Yoon-Seok Chang, and Sang-Heon Cho. School Absenteeism Associated with Asthma and Allergic Diseases in Korean School-Aged Children. Pediatric Allergy, Immunology, and Pulmonology. 2018;31(3):151-7.
3. Banac S, Rožmanić V, Manestar K, Korotaj-Rožmanić Z, Lah-Tomulić K, Vidović I, et al. Rising trends in the prevalence of asthma and allergic diseases among school children in the north-west coastal part of Croatia. Journal of Asthma. 2013;50(8):810-4.
4. Regamey N, Casaulta Aebischer C, Frey U. [Acute asthma attacks in childhood]. Ther Umsch. 2005;62(8):539-42.
5. Lee N, Rachelefsky G, Kobayashi RH, Kobayashi AL, Siegel SC, Katz RM, et al. 672 Comparison of efficacy and safety of albuterol administered by power-driven nebulizer (PDN) versus metered dose inhaler (MDI) with aerochamber and mask in young children with asthma. Journal of Allergy and Clinical Immunology.87(1):307.
6. Lewis RA, Fleming JS. Fractional deposition from a jet nebulizer: how it differs from a metered dose inhaler. Br J Dis Chest. 1985;79(4):361-7.
7. Robinson M, Hemming AL, Regnis JA, Wong AG, Bailey DL, Bautovich GJ, et al. Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis. Thorax. 1997;52(10):900-3.
8. Newman SP, Millar AB, Lennard-Jones TR, Moren F, Clarke SW. Improvement of pressurised aerosol deposition with Nebuhaler spacer device. Thorax. 1984;39(12):935-41.
9. Closa RM, Ceballos JM, Gomez-Papi A, Galiana AS, Gutierrez C, Marti-Henneber C. Efficacy of bronchodilators administered by nebulizers versus spacer devices in infants with acute wheezing. Pediatr Pulmonol. 1998;26(5):344-8.
10. Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW. Dexamethasone and salbutamol in the treatment of acute wheezing in infants. Pediatrics. 1983;71(1):13-8.
11. Hendeles L, Hatton RC, Coons TJ, Carlson L. Automatic replacement of albuterol nebulizer therapy by metered-dose inhaler and valved holding chamber. Am J Health Syst Pharm. 2005;62(10):1053-61.
12. Akinbami LJ, Moorman JE, Garbe PL, Sondik EJ. Status of childhood asthma in the United States, 1980-2007. Pediatrics. 2009;123 Suppl 3:S131-45.
13. Becker A, Bérubé D, Chad Z, Dolovich M, Ducharme F, D'Urzo T, et al. Canadian Pediatric Asthma Consensus Guidelines, 2003 (updated to December 2004): Introduction. CMAJ: Canadian Medical Association Journal. 2005;173(6 Suppl):S12-S4.
14. Benito-Fernandez J, Gonzalez-Balenciaga M, Capape-Zache S, Vazquez-Ronco MA, Mintegi-Raso S. Salbutamol via metered-dose inhaler with spacer versus nebulization for acute treatment of pediatric asthma in the emergency department. Pediatr Emerg Care. 2004;20(10):656-9.
15. Robertson CF, Norden MA, Fitzgerald DA, Connor FL, Van Asperen PP, Cooper PJ, et al. Treatment of acute asthma: salbutamol via jet nebuliser vs spacer and metered dose inhaler. J Paediatr Child Health. 1998;34(2):142-6.
16. Idris AH, McDermott MF, Raucci JC, Morrabel A, McGorray S, Hendeles L. Emergency department treatment of severe asthma. Metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Chest. 1993;103(3):665-72.
17. Doan Q, Shefrin A, Johnson D. Cost-effectiveness of metered-dose inhalers for asthma exacerbations in the pediatric emergency department. Pediatrics. 2011;127(5):e1105-11.
18. Delgado A, Chou KJ, Silver EJ, Crain EF. Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department. Arch Pediatr Adolesc Med. 2003;157(1):76-80.
19. Cohen HA, Cohen Z, Pomeranz AS, Czitron B, Kahan E. Bacterial Contamination of Spacer Devices Used by Asthmatic Children. Journal of Asthma. 2005;42(3):169-72.
20. Wildhaber JH, Waterer GW, Hall GL, Summers QA. Reducing electrostatic charge on spacer devices and bronchodilator response. Br J Clin Pharmacol. 2000;50(3):277-80.
IssueVol 57, No 11 (2019) QRcode
Asthma Metered-dose inhalers Nebulizer Salbutamol Wheezing

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Tabatabaii SA, Vahedi M, Khanbabaee G, Sadr S, Farahbakhsh N. Comparison of Salbutamol Delivered Via Jet Nebulizer With A Metered Dose Inhaler (MDI) Plus A Spacer for Asthma Exacerbation of Children: A Randomized Clinical Trial. Acta Med Iran. 2020;57(11):672-677.