d. He added that ‘nebulizers need a power supply, are less portable, require maintenance and are more difficult to clean than spacers.’
Carlos Camargo, Jr., M.D., Ph.D., of the Harvard School of Public Health, cautioned that the study results ‘apply to beta-agonist delivery only and not other agents, for example, inhaled corticosteroids.’ As for the most severely affected patients, ‘there are insufficient data on severe exacerbation to generalize to that high-risk group,’ Camargo said.
The authors conclude that the emergency- room results need to be replicated in a community setting. In the meantime, Cates said, the issue is ‘how to help people change practice from the familiar nebulization to using a spacer.’ He said that proper titration -- adjusting medication dose and timing according to symptoms -- is still ‘the key issue, whichever delivery method is used.’ An estimated 6.2 million U.S. children under age 18 years of age have asthma and 4 million of these had an asthma attack or episode in 2003, according to the American Lung Association. Asthma is the third leading cause of hospitalization in children under 15.
‘For adults seen and assessed for acute asthma, this review found no significant differences between the two delivery methods,’ the authors write. ‘Consequently, the choice of delivery method should reflect patient preference, practice situations and formal economic evaluation.’
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