Ever wonder why we give nebulized albuterol in the ED instead of a metered dose inhaler? Haven’t you heard form a colleague that “4 to 6 puffs is equivalent to a neb.” Perhaps some of this is convention, but there is evidence behind it. In an oldie but goodie form 1993 Idris et al performed a RCT to compare an inhaler versus neb. Patients 10-45 years of age. 20 got nebulizer and placebo MDI and 15 got MDI and placebo neb (see what they did here – patients got both, pretty savvy huh?). The doses were repeated q30minutes until FEV1 reached 80% of expected, the patient became asymptomatic, or the patient had received 6 doses. Ultimately, in this adequately powered study (beta=.9) they noted that:
- No significant (p > 0.58) differences occurred in baseline mean FEV1, FVC, or PEFR for the two groups
- For both groups, significant improvement occurred in mean FEV1 at 30 min (p < 0.02) and at 60 min (p < 0.02), and in maximum mean FEV1 (p < 0.001)
- However, no significant (p > 0.6) differences occurred between groups in mean FEV1, FVC, or PEFR at 30 and 60 min, or in maximum improvement attained
- Thirty-three of 35 patients were treated successfully with the study protocol, became asymptomatic, and were discharged home.
- One patient from each group required further treatment
The take home is that if you want to use MDIs in the ED or clinic you can be confident that they will work just as well as a nebulized treatment.
