Evidence-Based Nursing: Comparing Nebulizer and Spacer for Asthma

This report explores the effectiveness of nebulizers versus spacers in delivering salbutamol for treating asthma exacerbations in a 10-year-old child with bronchitis. It reviews various evidence-based articles, including randomized control trials, systematic reviews, and qualitative/quantitative studies, to compare the efficacy of these two methods. The literature review examines the use of metered-dose inhalers (MDIs) with spacers as a cost-effective alternative to nebulizers, highlighting the challenges young children face in coordinating MDIs and the benefits of spacers. The report also considers the impact of patient education on nebulizer use and the role of different spacer types in treatment compliance. Ultimately, the assignment aims to determine the more efficient method for controlling severe bronchitis in pediatric patients, considering factors such as patient convenience and ease of use, with resources like Desklib offering additional support through past papers and solved assignments.

Running head: EVIDENCE BASED NURSING
Evidence based nursing
Name of the student
University name
Author’s note

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Introduction
The current study focuses upon the aspect of evidence based nursing practices. The
implementation of such practices could help in the improvement of the overall quality of the
health and support services. Therefore, practising in an emergency department as a reporting
nurse I need to apply a number of evidence based practices which will help in effective
evaluation of the health condition of the patient. Additionally, implementation of the
evidence based practices helps to reduce the rates of medical negligence. In the current study,
a number of evidence based articles have been used to compare between nebulizer and spacer
for less than 10 years children. For facilitating the purpose of comparison different types of
study designs have been used such as randomised control deign, systematic review,
qualitative and quantitative study design.
In the current study, evidence based literature have been used to compare the
effective method of delivery of treatment to a 10 years old child affected with asthma
secondary to bronchitis. The chid has been admitted to the emergency ward of the hospital
and presented with the diagnosis of exacerbation of asthma. The patient has been suggested
salbutamol for the treatment which could be delivered either though a nebulizer or through a
spacer. The study here tries to compare the more effective mode of treatment for cure of the
asthma within the patient. The salbutamol is a bronchodilator which relaxes the muscles of
the airways, which leads to the lungs and improves the flow of air to and fro the lungs. The
effect of the medicine could be felt immediately within 5 minutes of inhalation. It produces
more quick effect upon inhalation as the vapours reach the lungs directly.

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Literature review
The current study compares between the efficacy rates of nebulizers and metered dose
inhalers in reducing the effects of asthma within children. It had been found through various
randomised control studies that the metered dose inhalers were as effective as nebulizers for
treatment of asthma within children. It has found that administering bronchodilators by
nebulizers in emergency departments owing to the volume of the patient and restricted
oxygen ports (Khoo eat al. 2009). The metered dose inhalers with spacers have been found to
produce quick and more cost effective way of delivery of bronchodilators to the patient. It
has been seen that the young children often find it difficult to coordinate inspiration with
activation of the Metered dose inhalers. However, the spacer allows the children to inhale
medications while normal breathing through a face mask. However, there are limitations with
the particular study design as it has focused upon the mode of delivery of the drug rather than
weighting the cumulative effects produced.
The second study adopted over here focuses upon the educating the patient
population regarding the correct use of nebulizers which reduces the rate of hospital
admission. Some of the particular intervention strategies which were used over here are-
provision of home treatment for acute symptoms , home based asthma education, symptom
recognition, , provision of appropriate asthma medication and nebulizer practice. It has been
summed up from the results of the study that home based education had slight or no
considerable effects in reducing the symptoms of asthma. In this case, a randomised control
trial had been set up for comparison of the results obtained from the study.
In this respect, a quantitative study design had been employed for comparison of the
different treatment modes and their methods of delivery. In the current a sample population
of 47 children were selected who were provided with various types of spacers. The spacer
types were further divided into AC+spacer and FH spacers. The children with AC+ spacers

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were discontinued on their daily anti-inflammatory drug delivery whereas the ones using the
FH spacers continued with the daily anti-inflammation medicine. It was found that the
children with the AC+ spacers took the inhalation activities more intently whereas the ones
with FC+ spacers treated the device more life a toy. Hence, it could be summed up that the
AC+ spacers were seen more as a medical device the encouraged the children to adopt a
serious attitude during inhalation. Later, it was found that the AC+ Spacers followed
compliance to good techniques. As suggested by Delgado et al. (2013) the quality of the
spacers were seen to aid the relief the mechanism within the children.
In a study, the effects on respiratory mechanics and heamodyanamics of administered
salbutamol through MDI and nebulizers were compared. A blind, randomised crossover
study in 12 intubated infants and children were conducted. The patients under study were
subjected to 0.15 mg/kg by SVN and four puffs (400 μg) by MDI plus spacer at a four hour
interval. The passive respiratory mechanism was studied by occlusion technique and serum
salbutamol concentrations were measured by liquid chromatography mass spectrometry (Butz
et al., 2013). The results declared no significant change in respiratory mechanisms of the two
administration methods.
A study has been conducted over here in order to review the affectivity of the MDI
over nebulizers. In this respect 50 patients with severe respiratory disorder undergoing MDI
spacer treatments were interviewed regarding the effects produced. It was seen that 96% of
the patients preferred use of nebulizer over MDI. This could be attributed to the inefficiency
of some of the patients in using MDI (Cates et al. 2016).
Conclusion
The current assignment compares the efficiency rates of nebulizer over MDI in
controlling the severe bronchitis within the patients. It had been seen that many patient had

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found MDI to be more effective than nebulizer. However, it mainly rested upon the
convenience of the patients, as some found using spacers difficult. Though, it had been seen
to facilitate breathing within children.
References
Butz, A.M., Tsoukleris, M.G., Donithan, M., Zuckerman, I., Mudd, K.E., Thompson, R.E.,
Rand, C. and Bollinger, M.E., 2006. Effectiveness of nebulizer use–targeted asthma
education on underserved children with asthma. Archives of pediatrics & adolescent
medicine, 160(6), pp.622-628. doi:10.1001/archpedi.160.6.622
Cates, C.J., Crilly, J.A. and Rowe, B.H., 2013. Holding chambers (spacers) versus nebulisers
for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev, 2. DOI:
10.1002/14651858.CD000052.pub3
Colacone, A., Afilalo, M., Wolkove, N. and Kreisman, H., 1993. A comparison of albuterol
administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute
asthma. Chest, 104(3), pp.835-841. DOI: https://doi.org/10.1016/0736-4679(94)90442-1
Delgado, A., Chou, K.J., Silver, E.J. and Crain, E.F., 2003. 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. Archives of pediatrics & adolescent
medicine, 157(1), pp.76-80. doi:10.1001/archpedi.157.1.76
Garner, S.S., Wiest, D.B., Bradley, J.W. and Habib, D.M., 2002. Two administration methods
for inhaled salbutamol in intubated patients. Archives of disease in childhood, 87(1), pp.49-
53. Retrieved from : http://adc.bmj.com/content/87/1/49

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Jenkins, S.C., Heaton, R.W., Fulton, T.J. and Moxham, J., 1987. Comparison of domiciliary
nebulized salbutamol and salbutamol from a metered-dose inhaler in stable chronic airflow
limitation. Chest, 91(6), pp.804-807. DOI: https://doi.org/10.1378/chest.91.6.804
Khoo, S.M., Tan, L.K., Said, N. and Lim, T.K., 2009. Metered-dose inhaler with spacer
instead of nebulizer during the outbreak of severe acute respiratory syndrome in
Singapore. Respiratory care, 54(7), pp.855-860. Retrieved from :
http://rc.rcjournal.com/content/54/7/855.short
Murdzoska, J., 2006. Effect of a paediatric incentive spacer and reinforcement of inhalation
technique training in preschool children. Retrieved from :
http://ro.ecu.edu.au/theses_hons/1128/