Nebulizers improve asthma outcomes in kids

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Following an asthma flare-up, children who are given inhaled corticosteroids (ICS) with a nebulizer are less likely to be re-hospitalized or need to go the ER than are their peers using steroids delivered by a non-nebulizer device, a new study shows.

The reason for this difference is unclear but it may relate to improved technique and compliance with nebulized devices, according to findings reported here at the annual meeting of the American College of Allergy, Asthma, and Immunology.

"The key issue is how do we reduce the large number of children who are seen in the ER or hospitalized for their asthma,” lead author Dr. Carlos A. Camargo, from Harvard Medical School in Boston, told Reuters Health. “Treatment with ICSs can help prevent such visits, but there’s been an ongoing debate about the best way to deliver these drugs.”

To investigate the best method of delivery, Camargo’s team assessed the outcomes of 1552 children who were given an ICS prescription within 30 days of being released from the hospital or ER for an asthma attack.

Seven hundred twenty-nine subjects were given nebulized ICS, while 823 received non-nebulized ICS, such as with a metered-dose inhaler and holding chamber. The nebulizer and non-nebulizer groups included 480 and 292 subjects, respectively, who were 4 years of age or younger.

The overall rate of repeat hospitalizations or ER visits was 12.4 percent, the researchers report.

Compared with the use of a non-nebulized ICS, treatment with a nebulized ICS reduced the risk of recurrent hospitalization or ER visits by 53 percent.

This reduction in risk was more pronounced in children 4 years of age or younger—62 percent—and slightly less dramatic in children between 5 and 8 years of age—52 percent.

“The findings leave you with the inescapable conclusion that either the study groups were different or prescribing ICS through a nebulizer is better,” Camargo said.

“We adjusted for age differences between the groups and the risk reduction seen with nebulized ICS held relatively steady,” he noted. Also, “if anything, the nebulized ICS group was sicker to start with than the non-nebulized ICS group.”

So why does ICS delivery through a nebulizer lead to better outcomes? Camargo said that there are “good data” to show that a nebulizer does not deliver these drugs more effectively than other devices. Instead, he believes it has to do with improved compliance with nebulizers, something that might only be apparent in “real-world” settings, not in clinical trials.

“In the real world, it could be that kids treated with nebulizers are more likely to actually get their medications than kids treated with other devices,” Camargo said. “Perhaps, it has to do with the mask used or because of greater parental involvement.”

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