Nebulizer vs. Spacer: Salbutamol Delivery in Children

This essay addresses the question of whether nebulizers or spacers are the more effective method for delivering salbutamol to children with asthma. The paper examines five peer-reviewed articles, focusing on the comparative effectiveness of each method. The articles include studies and guidelin...Read More

Running head: USING EVIDENCE TO INFORM CLINICAL DECISION MAKING
USING EVIDENCE TO INFORM CLINICAL DECISION MAKING
Name of the Student:
Name of the University:
Author Note:

1USING EVIDENCE TO INFORM CLINICAL DECISION MAKING
Introduction:
The paper is going to make a discussion on the proper delivery method of salbutamol in
the child asthma patients considering the options of nebulizer and spacer. A nebulizer can be
described as a machine that produces mist from the liquid medication, for the purpose of inhaling
by an asthma patient (Stangl and PARI Pharma 2013). Alternatively, a spacer is a type of tube,
made of plastic that helps the aerosolized medication from the inhaler device to end up in the
lungs of an individual, resulting in a better administration, even when using an inhaler device
(Richardson and Ar Patents 2018). The comparative effectiveness of the both administration
processes while using a nebulizer and a spacer with inhaler is supposed to be closely similar
from the technical terms. Yet the question is often asked which technique is better than the other,
especially in case of children since they are more vulnerable than the adults. There are five peer
reviewed articles selected in order to find the answer to this question. The first article chosen for
this aimed for updating the guidelines for the acute asthma treatment in the children of South
America. The reason behind choosing this paper is that this paper reviewed previous studies on
the use of nebulizer and spacer with inhaler in order to design a proper treatment guideline for
the children with asthma. Along with that the paper also reviewed the previous guidelines that
are used previously in order to compare them to the recommended practice (Kling et al. 2013).
The second article chosen in order to answer this question discussed various methods of
pulmonary drug delivery in the children. The rationale behind choosing this article was that the
article reviewed various aspects of the pulmonary drug delivery method in the children and thus
we can draw a conclusion from this paper that whether to use the nebulizer or the spacer with the
inhaler in case of children (Kwok and Chan 2014). The third article is a comparative study
between the use of the nebulizer and the spacer with inhaler while administering the beta-agonist

2USING EVIDENCE TO INFORM CLINICAL DECISION MAKING
drugs like the salbutamol. The study included the children as well as the adults (Cates, Welsh
and Rowe 2013). The article directly addresses the question to which this paper is focused on in
order to find the answers. The fourth article is also focused on the finding out whether the
nebulizers are better than the MDI-spacers or the efficacy is very similar in case of aerosolized
medication delivery in order to determine if the nebulizer use can be replaced by the spacer use
for a better use of the hospital resource (Alhaider, Alshehri and Al-Eid 2014). It was chosen
because along with taking a huge sample size of cases into consideration, this study was also
focused on the hospitalized children. The relevance of the study can be considered high. The
fifth article is also a comparative study focused on discovering the more clinically effective
method for treating the pre-school children with asthma and virus induced wheezing (Mitselou,
Hedlin and Hederos 2016). The reason behind selecting this article is that the article directly
addresses the same issue and focuses on the same question that this paper is focused on. In the
following discussion section, this paper is going to discuss every article that was chosen.
Discussion:
Article 1:
The article aimed for updating the South African guidelines regarding the treatment of
the children with asthma. It is focused on assessing the current evidences and making
recommendations in order to provide a better patient care to the children. The article considered
the literature reviews on the childhood asthma from the year 2000 to 2012 in order to make a
proper assessment on the current situation. The article concluded that in case of first-line
treatment, it is better to use the inhaler along with the spacer in case of asthma in the children.
Though in case of severe conditions, such as acute asthma, the child should be admitted to the
hospital and immediate use of nebulizer is required (Kling et al. 2013).

3USING EVIDENCE TO INFORM CLINICAL DECISION MAKING
Article 2:
This article is focused on finding the best method for delivering the pulmonary drug in
the children since their lungs are underdeveloped in comparison to the adults. The article
considers various method of pulmonary drug administration such as nebulizers, metered dose
inhalers (MDI) with spacers, face masks and soft mist inhalers. The article concludes that a
nebulizer is easier to administer in the children than that of an inhaler, since it can help them to
inhale at a natural pace, unlike the inhaler, which produces a puff of mist at a time for inhalation.
Even though the spacer help in rectifying this limitation of the inhaler, there is no specific
conclusion drawn identifying one method better than the other (Kwok and Chan 2014).
Article 3:
The paper aimed for making an assessment on whether the spacers with the inhaler is
similarly effective as nebulizers in providing relief to the patients with asthma while
administering the beta2-agonist drugs. The study used previous studies in order to find the
answer to this question. The conclusion drawn from this study was that there is no huge
differences found between the use of nebulizers and spacers with inhalers in the adults, though in
case of the children who have acute asthma the spacer is more advantageous than the nebulizers
(Cates, Welsh and Rowe 2013).
Article 4:
The paper is aimed at finding out the impact of the replacement of nebulizers with the
spacers along with MDI. The cost of using the nebulizers is higher than using the spacers. So the
focus of the study was if the proper use of spacers can be as effective as the nebulizers, in order
to cease the use of nebulizers. The study concluded that the use of spacer with proper care can be
as effective as the nebulizers and thus it is replaceable (Alhaider, Alshehri and Al-Eid 2014).

4USING EVIDENCE TO INFORM CLINICAL DECISION MAKING
Article 5:
This study was aimed at determining the comparative clinical effectiveness of the
nebulizers and the MDI-spacers while attempting to treat the pre-school children with acute
asthma. The study considered random clinical trials in a pediatric emergency department and
concluded that there is no significant difference in the efficacy of the two methods, while
administering the drugs in the pre-school children (Mitselou, Hedlin and Hederos 2016).
Conclusion:
From the conclusion of the first article, which recommended the use of nebulizer under
severe conditions, we can conclude that the authors of the article consider the method more
effective than the use of the spacers. From the second article we gather that when the children are
considered, the use of nebulizers is much easier. The article 3 offered a contradictory view,
concluding that even though the difference is not huge, in cases of acute asthma in the children,
the spacer has a few advantages over the nebulizers. The article 4 and 5 were not successful in
identifying a method better than the other. In fact the article 4 concluded the proper use of
spacers with MDI can replace the use of the nebulizers all together. Hence, it can be concluded
that both the methods can be equally effective if administered properly. However, the use of
spacers invites more chances of human error, which can result in less effectiveness of the
medication administration process. Along with that when it comes to children, there is an issue
of making things easier for them, which can be proved slightly difficult in case of using the
spacers. Thus in case of emergency cases, especially if that involves children and availability, the
nebulizers are more advisable to be used.

5USING EVIDENCE TO INFORM CLINICAL DECISION MAKING
References:
Alhaider, S.A., Alshehri, H.A. and Al-Eid, K., 2014. Replacing nebulizers by MDI-spacers for
bronchodilator and inhaled corticosteroid administration: Impact on the utilization of hospital
resources. International Journal of Pediatrics and Adolescent Medicine, 1(1), pp.26-30.
Cates, C.J., Welsh, E.J. and Rowe, B.H., 2013. Holding chambers (spacers) versus nebulisers for
beta‐agonist treatment of acute asthma. Cochrane database of systematic reviews, (9).
Kling, S., Zar, H.J., Levin, M.E., Green, R.J., Jeena, P.M., Risenga, S.M., Thula, S.A., Goussard,
P. and Gie, R.P., 2013. Guideline for the management of acute asthma in children: 2013 update-
Part 3: March 2013. SAMJ: South African Medical Journal, 103(3), pp.199-207.
Kwok, P.C.L. and Chan, H.K., 2014. Delivery of inhalation drugs to children for asthma and
other respiratory diseases. Advanced drug delivery reviews, 73, pp.83-88.
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.
Richardson Jr, A.S., Ar Patents LLC, 2018. Spacer device. U.S. Patent 10,014,677.
Stangl, R., PARI Pharma GmbH, 2013. Inhalation nebulizer. U.S. Patent 8,387,895.