Clinical Decision Making: Spacer or Nebulizer for Asthma Treatment

This report examines the use of evidence-based practice in determining the most effective method for delivering salbutamol to a 10-year-old child with asthma exacerbation secondary to bronchitis. The report begins with an introduction to evidence-based practice and the PICO framework, formulating a searchable question to compare the efficacy of spacers and nebulizers. The main body of the report analyzes four research articles, each exploring the clinical outcomes of using spacers versus nebulizers in pediatric asthma treatment. The articles discuss randomized clinical trials and studies comparing the effectiveness of each method, considering factors like medication delivery, patient outcomes, and ease of use. The report synthesizes the findings of these articles, highlighting the benefits and limitations of both spacers and nebulizers, and concludes with a discussion on the implications for clinical decision-making in the emergency department setting. The overall findings suggest that both spacers and nebulizers can be effective, and the choice may depend on factors such as patient preference and the specific clinical context. This assignment showcases the importance of evidence-based practice in nursing and provides insights into making informed decisions about asthma treatment.

Using Evidence To Inform
Clinical Decision Making

Table of Contents
Introduction......................................................................................................................................1
Main Body.......................................................................................................................................2
Conclusion.......................................................................................................................................4
REFERENCES................................................................................................................................5

Introduction
Evidence- based practice plays an important role in the nursing profession. The use of evidence
in practice ensures quality care to patients and it also increases the rate of optimal health
outcomes. In this case, the use of evidence- based practice is put into practical use in real life
medical situations. The scenario chosen has several important factors to note which are necessary
for formulating a searchable question using the PICO format. In scenario 3, a 10-year-old child
has been admitted to the emergency department for exacerbation of asthma secondary to
bronchitis. The patient has been prescribed salbutamol. The point of argument is which delivery
method is most effective, the use of a spacer or nebuliser for treatment.
Evidence based practice refers to an integration of best study evidence with clinical expertise and
values of patient. It includes the criterion of using those clinical procedures that have evidence
about their effects for treating specific health problem. However, it has been analysed that
evidence based practices are known to be more effective as well as efficient in order to treatment
disease for making people healthy. It involves the fact that evidence based practices are helpful
to ensure that specific clinical activities are effective in respect of treating health problem in
effective manner. It is necessary to establish more effective as well as efficient clinical decisions
on the basis of evidence based practices. Meanwhile the evidenced based practices are supportive
because of having number of fundamental components. It includes that best evidence that is
generally found in clinically related investigation which has been carried out with the help of
utilising sound methodology. Herein, it consists to have clinical expertise that can be described
as education of cumulated clinicians, experience and clinical abilities. Moreover, the evidence
based practices involves patient values that are a unique preferences, expectations and concerns
each patient brings to a clinical encounter respectively.
Evidence based clinical decision is required to be considered in order to deliver appropriate care
facilities for making people disease free. It includes making accurate decision by evaluating
evidence based practices in order to provide better facilities. Basically, it is necessary to make an
effective as well as efficient clinical procedures plan according to specific health issue for
wellness of people. It consist the fact that evidence based clinical decision will provide support
to improve quality of healthcare services in effective manner. However, it is beneficial to
establish appropriate plan of action including accurate medications and treatment in respect of
making an individual wellbeing. In context of this project, it is based on the case scenario of a
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child having the health issue of asthma. The child has an age of 10 years old that has been
admitted to healthcare department and diagnosed with the problem of exacerbation of asthma
secondary to bronchitis. The physician related to this case used to prescribe the salbutamol for
betterment of patient. This assignment will focus on PICO framework in order to discuss about
effectiveness of method used to deliver prescribed medication.
Main Body
To answer the following question. Firstly, I formulated a searchable question and developed a
search strategy by using the PICO format. Using credible databases to help find relevant research
in answering the question, in children are spacers or nebulisers most effective in the treatment of
exacerbation of asthma secondary to bronchitis.
PICO Question
Is spacer more effective as compared to nebuliser in order to carry out appropriate administration
of salbutamol for children?
P: Patient 10 year old child
I: Intervention Salbutamol via Spacer inhaler
C: Comparison Salbutamol via Nebuliser
O: Outcome Manage asthma secondary to bronchitis
Article 1
Considering the selected article, it is based on the objective ‘to compared administration of
bronchodilators by nebulisers with deliver of metred dose inhalers with spacers and to evaluate
the clinical effect of the treatment of acute asthma in preschool children’. It includes the
utilisation of an effective method that is randomised clinical trial in context of paediatric
emergency health department. However, it consist to consider preschool children suffering from
virus induced wheezing or acute asthma exacerbation were allocated randomly in terms of
receiving bronchodilator treatment with the help of nebuliser or via metred dose inhaler
(Mitselou, Hedlin and Hederos, 2016). This study involves the use of questions to gain
information from parents which provide support to analyse the collected information in effective
manner. Meanwhile, it has been analysed that use of nebuliser develop situation in which kids
has been started to cry then it is favourable to utilise the same. It has been evaluated that
comments provided were similar with each other regarding length of stay in PED and
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hospitalisation along with device acceptance. It is observed that there are no significant
differences in several aspects such as respiratory rate, oxygen saturation and heart rate at
baseline as well as after the treatment. It has been founded that spacer is as effective as the
nebuliser in terms of delivering medication to treat asthma.
Article 2
As mentioned in given article, it has been identified that an ideal dosage of albuterol with the
help of using metered dose inhalers in terms of acute childhood asthma is not well established. It
is based on the hypothesised that greater doses of albuterol would result in less duration of time
in hospital as well as lower admission rates. Basically, the method used in this study was
randomised controlled double-bind multicentre study that has been carried out in emergency
rooms by including patient having age group between 2 to 17 years old with moderate to severe
acute asthma (Muchao and et. al., 2016). In context of this investigation, the 119 patients with
similar baseline situations along with having no significant differences that were observed
among groups in the length of stay (P=0.48) or admission rate (P=0.55). It has been founded that
there are significance differences observed in FEV1, PRAM score and pulse oximetry changes
after one hour and at discharge or admission. It is observed that no differences were there in
regards to safety outcomes by administrating medication with the help of spacer inhaler. It means
that spacer is suitable for children in order to provide medication for making them healthy by
relieving symptoms of acute asthma.
Article 3
Considering the given research article, it has been analysed that it is based on the study of
evaluating effectiveness of spacers to deliver medication for children with asthma. It includes
that the spacers plays an important role for administration medication of asthma as they provides
a multitude of benefits in terms of reducing an actual need of coordinating inhalation along with
actuation as well as improving inhaler technique among sick people. However, it is observed that
spacers are more effective as well as efficient in terms of improving drug targeting via retaining
within the spacer large particles generally deposited in the oropharynx (Anderson and et. al.,
2018). It is favourable to support drug targeting with the help of developing a prolonged aerosol
cloud of fine particles in order to give the use increased duration of time for inhaling after
actuation respectively. Moreover, it is observed that this is specifically being significant among
young kids and elderly to deliver medication related to airways in more effective way.
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It has been founded that qualitative research method is used to gain relevant data with the help of
investigation history and features of spacers. It includes to carry out proper demonstration of
advantages of utilising spacers far outweigh their limitations. Moreover, it has been evaluated
that spacers are much effective method to deliver medications of asthma among kids.
Article 4
As mentioned in selected article, it has been studied that the objective address in this
investigation is to compare clinical efficiency of spacers and breath actuated nebulisers among
children. It includes the aspect about effectiveness of breath actuated nebuliser is the default
albuterol delivery method in specific paediatric emergency department. However, it has been
analysed that the randomised, nonblinded, noninferiority study was carried out by using one
paediatric tertiary emergency department (Snider and et. al., 2018). In addition to this, it has been
founded that albuterol therapy via MDI is noninferior to breathe actuated nebuliser in terms of
treating the mild to moderate asthma exacerbations among age group go children exist between 2
to 17 years. It includes the criterion of providing medication of asthma via using nebuliser is
effective.
It is observed that spacer and nebuliser, both are appropriate to deliver the medication of
salbutamol for asthma treatment. Some of children have started crying by using nebuliser due to
spacer is used for them; otherwise both methods are favourable for kids.
Conclusion
From the above assignment it has been concluded that evidence based practices plays an
important role in terms of improving effective ness of treatment and patient experience. It
incudes that evidence based clinical decision is more effective as well as efficient in order to
increase quality of medical services. However, it is necessary for care professionals to use
effective methods by making decision via evidence based practices which facilitate to deliver
better quality of care facilities for wellbeing of an individual.
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REFERENCES
Books and journals
Mitselou, N., Hedlin, G. and Hederos, C.A., 2016. Spacers versus nebulizers in treatment of
acute asthma–a prospective randomized study in preschool children. Journal of Asthma, 53(10),
pp.1059-1062.
Muchao, F.P. and et. al., 2016. Albuterol via metered‐dose inhaler in children: Lower doses are
effective, and higher doses are safe. Pediatric pulmonology, 51(11), pp.1122-1130.
Anderson, G. and et. al., 2018. Use of spacers for patients treated with pressurized metered dose
inhalers: focus on the VENTOLIN™ Mini Spacer. Expert opinion on drug delivery, 15(4),
pp.419-430.
Snider, M.A. and et. al., 2018. A Randomized Trial Comparing Metered Dose Inhalers and
Breath Actuated Nebulizers. The Journal of emergency medicine, 55(1), pp.7-14.
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