S J Cunningham1, E F Crain. 1. Division of General Pediatrics (Emergency Medicine), Albert Einstein College of Medicine, Bronx Municipal Hospital Center, NY.
Abstract
STUDY OBJECTIVE: To evaluate whether providing a spacer device and a single, brief demonstration regarding its proper use would result in earlier resolution of asthma symptoms, improved school attendance, and decreased frequency of unscheduled medical visits for asthma among children receiving noncontinuous care in an urban emergency department (ED). DESIGN: Randomized controlled trial. SETTING:Urban hospital pediatric ED. PARTICIPANTS: Eighty-four children with the chief complaint of asthma. INTERVENTION: Children were enrolled in the ED at the time of an asthma attack and randomly assigned to one of two treatment groups. The spacer group received an inhaled beta-agonist at discharge from the ED with a spacer device. The control group received inhaled or oral beta-agonists without a spacer device. Both groups received other medications at the discretion of the evaluating physician who was not the interviewer in any case. A baseline questionnaire was completed and follow-up by telephone was done at 1 week, and 2, 4, and 6 months after enrollment. MEASUREMENTS AND RESULTS: The spacer group reported significantly earlier resolution of wheezing (0 days vs 2 days, p < 0.01) at the 2- and 4-month follow-up assessments. They reported significantly fewer days of cough after an asthma attack at 2 months (1 day vs 3 days, p < 0.01) and 4 months (0 days vs 3 days, p < 0.01). The spacer group missed significantly fewer days of school following an asthma attack at 2 and 4 months (0 days vs 2 days, p = 0.05). There was no difference between the two groups on any outcome measures at the 1-week and 6-month follow-up assessments. CONCLUSIONS: Introducing a spacer device to patients in a busy, inner-city pediatric ED is an effective and efficient intervention that improves the functioning of asthmatic children in terms of resolution of cough and wheeze and school absenteeism.
RCT Entities:
STUDY OBJECTIVE: To evaluate whether providing a spacer device and a single, brief demonstration regarding its proper use would result in earlier resolution of asthma symptoms, improved school attendance, and decreased frequency of unscheduled medical visits for asthma among children receiving noncontinuous care in an urban emergency department (ED). DESIGN: Randomized controlled trial. SETTING: Urban hospital pediatric ED. PARTICIPANTS: Eighty-four children with the chief complaint of asthma. INTERVENTION: Children were enrolled in the ED at the time of an asthma attack and randomly assigned to one of two treatment groups. The spacer group received an inhaled beta-agonist at discharge from the ED with a spacer device. The control group received inhaled or oral beta-agonists without a spacer device. Both groups received other medications at the discretion of the evaluating physician who was not the interviewer in any case. A baseline questionnaire was completed and follow-up by telephone was done at 1 week, and 2, 4, and 6 months after enrollment. MEASUREMENTS AND RESULTS: The spacer group reported significantly earlier resolution of wheezing (0 days vs 2 days, p < 0.01) at the 2- and 4-month follow-up assessments. They reported significantly fewer days of cough after an asthma attack at 2 months (1 day vs 3 days, p < 0.01) and 4 months (0 days vs 3 days, p < 0.01). The spacer group missed significantly fewer days of school following an asthma attack at 2 and 4 months (0 days vs 2 days, p = 0.05). There was no difference between the two groups on any outcome measures at the 1-week and 6-month follow-up assessments. CONCLUSIONS: Introducing a spacer device to patients in a busy, inner-city pediatric ED is an effective and efficient intervention that improves the functioning of asthmatic children in terms of resolution of cough and wheeze and school absenteeism.