Anopen, prospective comparison of132 agonists given vianebuliser, Nebuhaler, orpressurised inhaler byambulance crewasemergency treatment

Background - Themeritsoftheuseof P2agonists byambulance crew andbest methodsofdelivery havenotbeenfully explored. Methods-A prospective comparison has beenmadeoftreatments applied inthree districts inSouthWales(200Itg salbutamol bypressurised inhaler, 5mg salbutamol vianebuliser, and5mg terbutaline via Nebuhaler) byemergency ambulance personnel toacutely wheezy patients enroute tohospital. Pulserate,respiratory rate, peakexpiratory flowrate(PEFR),and breathlessness scored onavisual analogue scalewerecomparedbeforeand after treatment. Datawerecollected ondiagnosis,artificial ventilation, cardiorespiratory arrest, anddeath. Results - Thirty eightpatients received salbutamol inhaler, 51salbutamol vianebuliser, and41terbutaline viaNebuhaler. Thereweregreaterreductions in respiratory rateandbreathlessness score andmoreimprovement inPEFR inthe groupreceiving nebulised salbutamol than intheothertwogroups. No patient was ventilated andofthefive deaths nonewas causedbyasthma. Conclusions - For wheezy,breathless patients treated enroutetohospital by emergencyambulancepersonnel, 5mg salbutamol given byanoxygen-driven nebuliser wasmoreeffective thaneither 5mg terbutaline viaaNebuhaler or200Ftg salbutamolviaapressurised inhaler. (Thorax 1995;50:79-80)