Main Article Content
asthma, children, salbutamol, PRAM, metered-dose inhaler, spacer
Background: The Pediatric Respiratory Assessment Measure (PRAM) score is a useful tool for the assessment of asthma exacerbations in children. This study aimed to estimate the risk of hospitalization in children, assessed with the PRAM score and having mild–moderate asthma exacerbation, who were treated with salbutamol delivered via a metered-dose inhaler and spacer (MDI/S).
Methods: The study population consisted of children aged 3–16 years with mild–moderate asthma exacerbations. All children received 1mg/kg prednisolone p.o. (max 40 mg) and 4–6 puffs of salbutamol via MDI/S.
Results: Fifty patients participated in the study. Admission was associated positively with the initial PRAM score (OR: 18.91, CI: 2.42–123.12, P = 0.005) and negatively with the improvement in PRAM score (OR: 0.52, CI: 0.01–0.78, P = 0.032).
Conclusion: PRAM is a reliable tool that can be used effectively to estimate the asthma exacerbation severity.
2. Manti S, Licari A, Leonardi S, Marseglia GL. Management of asthma exacerbations in the paediatric population: A systematic review. Eur Respir Rev. 2021;30(161):200367. 10.1183/16000617.0367-2020
3. Payares-Salamanca L, Contreras-Arrieta S, Florez-García V, Barrios-Sanjuanelo A, Stand-Niño I, Rodriguez-Martinez CE. Metered-dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta-analysis. Pediatr Pulmonol. 2020;55(12):3268–78. 10.1002/ppul.25077
4. Breuer O, Shoseyov D, Kerem E, Brooks R. Implementation of a policy change: Replacement of nebulizers by spacers for the treatment of asthma in children. Isr Med Assoc J. 2015;17(7):421–4.
5. Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, et al. Global Initiative for Asthma Strategy 2021: Executive summary and rationale for key changes. Eur Respir J. 2022;59(1):2102730. 10.1183/13993003.02730-2021
6. Alnaji F, Zemek R, Barrowman N, Plint A. PRAM score as predictor of pediatric asthma hospitalization. Acad Emerg Med. 2014;21(8):872–8. 10.1111/acem.12422
7. De Benedictis FM, Selvaggio D. Use of inhaler devices in pediatric asthma. Paediatr Drugs. 2003;5(9):629–38. 10.2165/00148581-200305090-00005
8. Ditcham W, Murdzoska J, Zhang G, Roller C, von Hollen D, Nikander K, et al. Lung deposition of 99mTc-radiolabeled albuterol delivered through a pressurized metered dose inhaler and spacer with facemask or mouthpiece in children with asthma. J Aerosol Med Pulm Drug Deliv. 2014;27 Suppl 1:S63–75. 10.1089/jamp.2014.1139
9. Doan Q, Shefrin A, Johnson D. Cost-effectiveness of metered-dose inhalers for asthma exacerbations in the pediatric emergency department. Pediatrics. 2011;127(5):e1105–11. 10.1542/peds.2010-2963
10. Leversha AM, Campanella SG, Aickin RP, Asher MI. Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma. J Pediatr. 2000;136(4):497–502. 10.1016/s0022-3476(00)90013-1
11. Castro-Rodriguez JA, Rodrigo GJ. beta-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: A systematic review with meta-analysis. J Pediatr. 2004;145(2):172–7. 10.1016/j.jpeds.2004.04.007
12. Staggs L, Peek M, Southard G, Gracely E, Baxendale S, Cross KP, et al. Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems. J Med Econ. 2012; 15(4):704–11. 10.3111/13696998.2012.674587
13. Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013;2013(9):Cd000052. 10.1002/14651858.CD000052.pub3
14. Rodriguez-Martinez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Metered-dose inhalers vs nebulization for the delivery of albuterol in pediatric asthma exacerbations: A cost-effectiveness analysis in a middle-income country. Pediatr Pulmonol. 2020;55(4):866–73. 10.1002/ppul.24650
15. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review. PLoS One. 2012;7(4):e35797. 10.1371/journal.pone.0035797
16. Cotterell EM, Gazarian M, Henry RL, O’Meara MW, Wales SR. Child and parent satisfaction with the use of spacer devices in acute asthma. J Paediatr Child Health. 2002;38(6):604–7. 10.1046/j.1440-1754.2002.00063.x
17. Licari A, Manti S, Chiappini E, Ciprandi G, Marseglia GL. Severe asthma in children: Current goals and unmet needs. Pediatr Allergy Immunol. 2020;31 Suppl 24:40–2. 10.1111/pai.13168