1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Are Nebulizers Obsolete for Asthma Therapy?

Two recent reviews concluded that a metered-dose inhaler (MDI), when used with a valved aerosol holding chamber (VHC), is as effective as a small-volume nebulizer (SVN) in treating acute asthma (see JW Oct 15 1997, p. 157, accession number 970926002, and Arch Pediatr Adolesc Med 1997; 151:876; also Arch Intern Med 1997; 157:1736). So why are nebulizers still commonly used? Two studies offer new findings.

In the first, 90 children presenting to an emergency department with a mild asthma exacerbation were randomized to one of three treatments: 2 puffs of albuterol given by an MDI with a VHC, 6 to 10 puffs administered similarly, or albuterol by SVN. There were no significant differences in FEV₁ improvement, clinical score, or oxygen saturation, but the nebulizer group had greater increases in heart rate. In the second study, an SVN was found to deliver a greater total dose of salbutamol and a greater dose per minute into the lungs of 17 asthmatic children than did an MDI with VHC.

Comment: An editorialist feels that use of small-volume nebulizers is "unsupportable" unless no MDI formulation of a drug is available. He is not impressed by the results of the second study, arguing that MDI with VHC could deliver the same dose as the nebulizer if more puffs were used. Efficacy, lower cost, greater convenience, and patient preference are all compelling reasons to use an MDI with VHC.

— RA Dershewitz

Published in Journal Watch General Medicine August 13, 1999

Citation(s):

Schuh S et al. Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma. J Pediatr 1999 Jul 135 22-27.

• Medline abstract (Free)

Wildhaber JH et al. Inhalation therapy in asthma: Nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children. J Pediatr 1999 Jul 135 28-33.

• Medline abstract (Free)

Newhouse MT. Asthma therapy with aerosols: Are nebulizers obsolete? A continuing controversy. J Pediatr 1999 Jul 135 5-8.

• Medline abstract (Free)