Effectiveness and Cost Study Comparing Two Ways to Deliver Albuterol for the Treatment of Asthma in the Hospital

January 13, 2015 updated by: Akron Children's Hospital

Effectiveness and Costs of Albuterol Delivered by MDI With Spacer Versus Nebulizer in Children Hospitalized With Moderate and Severe Asthma Exacerbations

This study will be conducted as a randomized, double blinded, controlled trial. The control group will receive albuterol delivered by a nebulizer along with placebo treatments delivered by a metered dose inhaler (MDI) with a spacer +/- mask. The experimental group will receive albuterol delivered by MDI with spacer +/- mask along with placebo treatments given by a nebulizer. Parents, participants, study personnel, nursing staff, and respiratory therapists will not know the treatment assignments of participants. The primary outcome will be changes over time in an asthma severity score, the Clinical Asthma Score (CAS) (Parkin et al. 1996). The secondary outcomes will be total number of albuterol treatments received in the hospital, time it take to give treatments, time till subjects' albuterol treatments are given at four hour intervals, and the costs of the two types of treatments. The study hypothesis is that albuterol delivered by metered dose inhaler with spacer is non-inferior to albuterol delivered by nebulizer in the treatment of children hospitalized with moderate to severe asthma exacerbations.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Studies looking at the use of beta-2-agonists given by MDIs with a spacer and mask in children greater than 2 years have described fewer side effects than when the same medications are given as nebulizers. Patients have less tachycardia, vomiting, and oxygen desaturation (Kerem et al. 1993, Chou, Cunningham and Crain 1995, Lin and Hsieh 1995, Pendergast et al. 1989, Fuglsang and Pedersen 1986).

In the emergency department setting, Rubilar et. al found that albuterol delivered by MDI with spacer and mask had equal efficacy to albuterol delivered by a nebulizer in treating acute wheezing in children less than 2 years of age. (Rubilar, Castro-Rodriguez and Girardi 2000) Chou et. al found that in children greater than 2 years old with acute asthma exacerbations, MDIs had the same efficacy as nebulizers but with a shorter delivery time and fewer side effects.(Chou et al. 1995)

All children who meet criteria to be participants in the study will be approached for possible study enrollment in the ED. No outside recruiting will be done. Once consent has been obtained and patients are enrolled, they will be randomized to either albuterol by MDI with placebo nebulizer treatments or albuterol by nebulizer with placebo MDI treatments. Subjects will be randomized to one of the two treatment arms in a 1:1 randomization process. This will be done using a prepared assignment log developed using a random number generator.

Children in the control arm will receive albuterol via nebulizer and placebo by MDI with spacer +/- mask. Children in the experimental arm will receive albuterol by MDI and placebo by nebulizer.

All MDI treatments will be given with a spacer +/- mask. Subjects will receive 6 puffs if they are < 30 kg and 10 puffs if they are > 30 kg. If they are in the control group, puffs will be placebo. If they are in the experimental group, puffs will be albuterol (90 micrograms per puff).

For the nebulizer treatments, patients in the control group will receive 2.5 mg albuterol (if <30 kg) or 5 mg of albuterol (if 30 kg or greater) in 3 ml of normal saline. Patients in the experimental group will receive nebulizer treatments as 3 ml of normal saline. Nebulized treatments will be delivered with room air unless the subjects are on oxygen.

All study medication will be administered by clinical nursing staff or respiratory therapists. The frequency at which albuterol is given will be determined by the subject's primary medical team. For all subjects, MDI treatments will be given first followed by nebulizer treatments.

Nursing staff will record a Clinical Asthma Score (CAS) (Parkin et. al 1996) on admission and every 4 hours during hospitalization up to 72 hours or discharge (whichever comes first). Nursing staff will also record the total number of albuterol treatments given and the time required to give each treatment. Patients' total length of stay will be calculated. A cost analysis will be done to determine if there are any differences in the costs to the hospital of the two delivery devices. This analysis will include the costs of the albuterol and delivery devices and the labor costs related to nursing or respiratory therapists' time to administer the medications. Information on subjects' baseline level of asthma severity will also be collected at the beginning of the study.

All study patients will be given prednisolone, prednisone or solumedrol at a dose of 1 mg/kg/dose twice a day for a total of 5 days. The length of steroid treatment can be extended beyond 5 days if felt to be clinically indicated by the subject's attending physician.

Controller medications such as long acting beta-2-agonists, inhaled corticosteroids, and leukotriene inhibitors will be given at the discretion of the subject's in patient attending. All controller medications used before and during hospitalization will be recorded as part of the study data.

Study Type

Interventional

Enrollment (Actual)

11

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Ohio
      • Akron, Ohio, United States, 44308-1062
        • Akron Children's Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

1 year to 18 years (ADULT, CHILD)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Children 1 to 18 years of age with a known history of asthma being admitted to Akron Children's Hospital general medical floor for the treatment of moderate to severe asthma exacerbations

Exclusion Criteria:

  • Children who have a concurrent pneumonia or bronchiolitis (diagnosed clinically or by chest x-ray)
  • Have a diagnosis of chronic lung disease (ex. cystic fibrosis, bronchopulmonary dysplasia, chronic aspiration)
  • Have cyanotic congenital heart disease, a congenital anomaly of the respiratory tract, or who are tracheostomy or ventilator dependent.
  • Children who are determined by the Emergency Department (ED) or general pediatrics service to need ICU level care on admission will also be excluded.
  • Children will also be excluded if their legal guardian does not speak English as all consent forms will be written and reviewed with guardians in English.
  • Children will also be excluded if their legal guardians disagree on consent to participate, or if a child 9 years or older and their legal guardians disagree on study participation.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: QUADRUPLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: 1
Subjects receive active medication (albuterol) delivered by a Proair metered dose inhaler used with an Opti-chamber and placebo (normal saline solution) by nebulizer aerosol.
Device: Metered Dose Inhaler & Optichamber Advantage Valve Holding Chamber (VHC)
Albuterol is delivered by metered dose inhaler with valved holding chamber. For children less than 6 years of age, a mask is also used.
ACTIVE_COMPARATOR: 2
Subjects receive active medication (albuterol) delivered by nebulizer and placebo (no medicine) delivered by a demonstrator Placebo metered dose inhaler demonstrator.
Device: Airlife Sidestream High Efficiency Nebulizer
Albuterol is delivered as a mist mixed with normal saline using a nebulizer machine and face mask or mouth piece.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Change in Clinical Asthma Severity score over time
Time Frame: 72 hours
72 hours

Secondary Outcome Measures

Outcome Measure
Time Frame
Time to discharge
Time Frame: Total time in the hospital
Total time in the hospital
Time to when are able to go 4 hours between albuterol treatments
Time Frame: Time in hospital
Time in hospital
Cost of delivering albuterol by MDI versus nebulizer
Time Frame: Time in hospital
Time in hospital

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Akron Children's Hospital

Investigators

  • Principal Investigator: Kimberly A Spoonhower, M.D., Akron Children's Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

February 1, 2008

Primary Completion (ACTUAL)

April 1, 2012

Study Completion (ACTUAL)

April 1, 2012

Study Registration Dates

First Submitted

February 6, 2008

First Submitted That Met QC Criteria

February 15, 2008

First Posted (ESTIMATE)

February 26, 2008

Study Record Updates

Last Update Posted (ESTIMATE)

January 14, 2015

Last Update Submitted That Met QC Criteria

January 13, 2015

Last Verified

January 1, 2015

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 070908

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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