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OBJETIVO: Verificar a eficácia, eventos adversos e custo do tratamento da crise aguda de asma, utilizando diferentes dispositivos inalatórios. MÉTODOS: Estudo randomizado, duplo-cego e controlado com placebo. Foi utilizado salbutamol em nebulizador, inalador dosimetrado com espaçadores industrial e artesanal e inalador em pó. As avaliações foram feitas em 0, 20, 40 e 60 minutos, seguidas da aplicação de salbutamol e placebo em outro dispositivo. Foram avaliadas 40 crianças em crise aguda de asma, com média de idade = 11±3,5 anos. Utilizou-se escore clínico e função pulmonar, e foram verificados eventos adversos. Foram calculados gastos com o medicamento e o dispositivo inalatório. RESULTADOS: O escore clínico e a variação no volume expiratório forçado no primeiro segundo foram semelhantes entre os grupos ao final do estudo. Foi encontrada uma variação maior na freqüência cardíaca com o uso de nebulizador (35%) do que nos grupos que fizeram uso do espaçador industrial (15%) e do inalador em pó (17%), e também entre os espaçadores artesanal e industrial, 28 e 15%, respectivamente (p = 0,004). O nebulizador e o espaçador artesanal provocaram mais tremores (p = 0,02). O custo do tratamento por paciente foi maior nos grupos nebulizador e espaçador industrial, R$ 22,31 e R$ 16,58, respectivamente (p = 0,0001). CONCLUSÕES: O nebulizador foi o mais caro e consumiu mais droga para apresentar a mesma eficácia. O espaçador artesanal foi o mais barato. No entanto, apresentou mais eventos adversos do que o espaçador industrial e o inalador em pó. O espaçador industrial foi tão caro quanto o nebulizador, porém mais seguro. O inalador em pó foi mais barato e apresentou menos tremores, mas taquicardia semelhante ao espaçador artesanal.OBJECTIVE: To verify the efficacy, side effects, and cost of treatment of acute asthma attacks, using different inhaler devices. METHODS: This is a randomized, double-blind, placebo-controlled study. Salbutamol was administered via a nebulizer, a metered-dose inhaler (attached to a commercially available spacer device), a homemade non-valved spacer device, or a dry powder inhaler. Assessments were made at zero, 20, 40 and 60 minutes, followed by the application of salbutamol and placebo with another device. Forty children (mean age of 11±3.5 years) with acute asthma attacks, were evaluated. Clinical score, forced expiratory volume in one second and side effects were analyzed. The costs for medication and spacer devices were calculated. RESULTS: There is no difference between groups regarding clinical score and variation of forced expiratory volume in one second. There was a major variation in the heart rate response to the nebulizer (35%) compared to the commercially available spacer and dry powder inhaler (15 and 17%) and between the homemade spacer and the commercially available spacer (28 and 15%) (p = 0.004). The nebulizer and homemade spacer caused more tremor (p = 0.02). The cost of treatment was higher for the nebulizer and commercially available spacer (p = 0.0001). CONCLUSIONS: The nebulizer was more expensive and used more medicine, showing the same efficiency. The homemade spacer was cheaper, but presented more side effects. The commercially available spacer was as expensive as the nebulizer, although safer. The dry powder inhaler was cheaper, but, just as the homemade spacer, it also caused tachycardia.

Metered dose inhaler (MDI) with spacer is the preferred method for administration of aerosolized medications in pediatric asthma. The expense of commercial spacers limits their use and indigenous alternatives have therefore been developed. Information on the clinical efficacy of home-made spacers is limited. This study was conducted to compare the efficacy of a valve-less home-made spacer with a commercial spacer in delivering salbutamol via MDI in acute asthma. Asthmatic children aged 5-15 years who presented with an acute exacerbation to the pediatric chest clinic of a tertiary care hospital were enrolled in a single blinded randomized parallel group study. The study patients received 10 puffs of salbutamol (100 microg/puff) via MDI-home-made spacer or MDI-commercial spacer. Pre and post inhalation measurements of peak expiratory flow rate (PEFR), oxygen saturation (SaO2), respiratory rate (RR), pulse rate (PR) were made and compared. Sixty children were enrolled in the study, 31 were administered salbutamol via the home-made spacer and 29 via the commercial spacer. The median increase in PEFR was similar in both the groups (20.8% vs 22.2%, p=0.4), clinical improvement being satisfactory in all patients. The valve-less home-made spacer is equally efficacious and cheaper than the commercial spacer in administering bronchodilators in acute exacerbations of asthma. Further studies on the efficacy of home-made spacer in delivery of inhaled steroids are needed. [ABSTRACT FROM AUTHOR]