Nebulisers are recommended in the treatment of acute asthma in children. As choosing the right system can be a crucial factor for a successful aerosol therapy in children, the performance of 5 relevant jet nebulisers was determined. Methods Aerosol delivery of albuterol (Sultanol forte® 2.5 mg/2.5 ml) with 5 different jet nebuliser systems (from PARI, MPV, Omron and PHILmed/3A HEALTH CARE) was assessed over 4 min and analysed by HPLC. With a PARI Compas II breath simulator a child9s breathing pattern was mimicked according to Barry/O9Callaghan (1995; n=6). The aerodynamic particle size distribution was determined by a Next Generation Impactor (NGI, Ph.Eur.7.0, Copley Scientific, 15 L/min, n=4). Respirable Drug Delivery Rate (RDDR) was calculated by multiplying the drug delivery rate (DDR) by the Respirable Fraction (%of droplets ≤ 5µm). Results The DDR during the first 4 min of nebulisation differed from maximal 80 µg/min (PARI LC Sprint Junior) to minimal 28 µg/min (AmpollaNebjet). Two of the nebulisers (PARI; MPV MicrodropCalimero) showed a Mass Median Aerodynamic Diameter (MMAD) of approx. 3 µm which is considered as eligible droplet size for children. The RDDR (a predictor for the respirable drug dose per time) varied by a factor of 4 between the systems tested. Conclusion In vitro performance of the 5 nebulisers differs considerably. For children nebulisers with a high RDDR should be selected in order to ensure the best possible therapeutic outcome and adherence.
Twenty patients with asthma were studied. They were given either fenoterol powder or fenoterol MDI for 2‐week periods using a double‐blind cross‐over design. Identical doses of fenoterol (0.2–0.4 mg 2–4 times daily) were given to an individual patient throughout the 4‐week study period. Both forms of treatment produced an almost identical bronchodilation, and there were no statistically significant differences in symptoms or side effects. It is concluded that fenoterol powder and fenoterol aerosol are equally effective.
Objective: To compare the efficacy of self management of asthma with traditional treatment. Design: 12 month prospective randomised trial. Setting: Outpatient clinics in Finland. Subjects: 115 patients with mild to moderately severe asthma. Interventions: Patient education and adjustment of anti-inflammatory therapy guided by peak flow measurements. Main outcome measures: Unscheduled admissions to hospital and outpatient visits, days off work, courses of antibiotics and prednisolone, lung function, and quality of life. Results: The mean number of unscheduled visits to ambulatory care facilities (0.5 v 1.0), days off work (2.8 v 4.8), and courses of antibiotics (0.4 v 0.9) and prednisolone (0.4 v 1.0) per patient were lower and the quality of life score (16.6 v 8.4 at 12 months) higher in the self management group than in the traditionally treated group. In both groups admissions for asthma were rare. Conclusions: Self management reduces incidents caused by asthma and improves quality of life.
Key messages
Key messages This trial of 115 patients with mild to moderately severe disease randomised half to a traditional care and half to a self management programme consisting of education about asthma and daily peak flow readings Intervention thresholds of < 85% of the optimal peak flow for doubling the dose of inhaled steroid for two weeks and of < 70% of the optimal peak flow for starting a course of oral steroids worked well The self management group had fewer incidents (consultations, days off work, courses of prednisolone or antibiotics) than the traditionally treated group and better quality of life scores Adherence of patients to the self management instructions was better than expected
