Abstract
Background The Circulaire nebulizer (C-Neb) is marketed as superior to low-dose albuterol for acute bronchospasm. Methods This clinical trial design compared clinical and fiscal outcomes of patients treated with C-Neb and high-dose albuterol (HDA). Eligibility criteria included reactive airway disease, age >5 years, and asthma score (AS) of 2 to 10. Patients with odd medical record numbers received HDA, and those with even numbers received C-Neb. Treatment was concluded if AS was 0, peak flow was >70% predicted, or after three treatments. Results One hundred eight patients were enrolled: 48 received HDA, 52 received C-Neb, and 8 were excluded. The two groups were comparable by admission rates (G2 = 0.90, P = 0.34), return visit rates (G2 = 0.73, P = 0.39), and final AS (z = 0.59, P = 0.55). Side effects were similar: change in heart rate (t = 1.61, P = 0.11) and mean arterial pressure (t = 1.36, P = 0.17). Charges per treatment, per delivery, and total charges were greater for HDA. Conclusion The C-Neb is equally effective, has similar side effects, and requires less time and charges than HDA.
This content is limited to qualifying members.
If you have an existing account please login now to access this article or view purchase options.
Create a free account, then purchase this article to download or access it online for 24 hours.
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
References
References 1. Jagoda A, Shepherd SM, Spevitz A, Joseph MM. Refractory asthma: Part 1—Epidemiology, pathophysiology, pharmacologic interventions. Ann Emerg Med 1997; 29: 262–274.JagodaA]]ShepherdSM]]SpevitzA]]JosephMMRefractory asthma: Part 1—Epidemiology, pathophysiology, pharmacologic interventionsAnn Emerg Med199729262 2. Henderson SO, Acharya P, Kilaghbian T, Perez J, Korn CS, Chan LS. Use of heliox-driven nebulizer therapy in the treatment of acute asthma. Ann Emerg Med 1999; 33: 141–146.HendersonSO]]AcharyaP]]KilaghbianT]]PerezJ]]KornCS]]ChanLSUse of heliox-driven nebulizer therapy in the treatment of acute asthmaAnn Emerg Med199933141 3. Grant EN, Wagner R, Weiss KB. Observations on emerging patterns of asthma in our society. J Allergy Clin Immunol 1999; 104: S1–S9.GrantEN]]WagnerR]]WeissKBObservations on emerging patterns of asthma in our societyJ Allergy Clin Immunol1999104S1 4. Crain EF, Weiss KB, Fagan MJ. Pediatric asthma care in US emergency departments: Current practice in the context of the National Institutes of Health guidelines. Arch Pediatr Adolesc Med 1995; 149: 893–901.CrainEF]]WeissKB]]FaganMJPediatric asthma care in US emergency departments: Current practice in the context of the National Institutes of Health guidelinesArch Pediatr Adolesc Med1995149893 5. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med 1992; 326: 862–866.WeissKB]]GergenPJ]]HodgsonTAAn economic evaluation of asthma in the United StatesN Engl J Med1992326862 6. Schuh S, Parkin P, Rajan A, Canny G, Healy R, Rieder M, et al. High-versus low-dose, frequently administered, nebulized albuterol in children with severe, acute asthma. Pediatrics 1989; 83: 513–518.SchuhS]]ParkinP]]RajanA]]CannyG]]HealyR]]RiederMHigh-versus low-dose, frequently administered, nebulized albuterol in children with severe, acute asthmaPediatrics198983513 7. Papo MC, Frank J, Thompson AE. A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children. Crit Care Med 1993; 21: 1479–1486.PapoMC]]FrankJ]]ThompsonAEA prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in childrenCrit Care Med1993211479 8. American Association for Respiratory Care. Aerosol consensus statement: 1991. Respir Care 1991; 36: 916–921.American Association for Respiratory Care.Aerosol consensus statement: 1991Respir Care199136916 9. Lewis RA, Fleming JS. Fractional deposition from a jet nebulizer: How it differs from a metered dose inhaler. Br J Dis Chest 1985; 79: 361–367.LewisRA]]FlemingJSFractional deposition from a jet nebulizer: How it differs from a metered dose inhalerBr J Dis Chest198579361 10. Hoffman L, Smithline H. Comparison of Circulaire to conventional small volume nebulizer for the treatment of bronchospasm in the emergency department. Respir Care 1997; 42: 1170–1174.HoffmanL]]SmithlineHComparison of Circulaire to conventional small volume nebulizer for the treatment of bronchospasm in the emergency departmentRespir Care1997421170 11. Mason J, Miller W, Small S. Comparison of aerosol delivery via Circulaire system vs conventional small volume nebulizer. Respir Care 1994; 39: 1157–1161.MasonJ]]MillerW]]SmallSComparison of aerosol delivery via Circulaire system vs conventional small volume nebulizerRespir Care1994391157 12. Morrow PE. Conference on the Scientific Basis of Respiratory Therapy: Aerosol therapy—Aerosol characterization and deposition. Am Rev Respir Dis 1974; 110: 88–99.MorrowPEConference on the Scientific Basis of Respiratory Therapy: Aerosol therapy—Aerosol characterization and depositionAm Rev Respir Dis197411088 13. Hess D, Fisher D, Williams P, Pooler S, Kacmarek RM. Medication nebulizer performance: Effects of diluent volume, nebulizer flow, and nebulizer brand. Chest 1996; 110: 498–505.HessD]]FisherD]]WilliamsP]]PoolerS]]KacmarekRMMedication nebulizer performance: Effects of diluent volume, nebulizer flow, and nebulizer brandChest1996110498 14. Yung M, South M, Byrt T. Evaluation of an asthma severity score. J Paediatr Child Health 1996; 32: 261–264.YungM]]SouthM]]ByrtTEvaluation of an asthma severity scoreJ Paediatr Child Health199632261
