Abstract
Background: Acute wheeze is a common reason for young children to present to hospital. Local protocol, based on BTS/SIGN guidelines, recommends beta2 agonist metered dose inhaler (MDI) with spacer, rather than nebuliser, in those without severe or life-threatening signs (tachypnoea, tachycardia and hypoxia).
Aims and Objectives: We hypothesised that in most young children with acute wheeze early use of nebulisers would not confer additional benefit in controlling symptoms compared with MDI alone.
Methods: Medical records were reviewed for all children aged 1-5 years admitted to our hospital with acute wheeze over 30 days. We compared those who received at least one nebuliser vs. MDI alone by analysing initial observations at presentation and improvement over the first 4 hours.
Results: 190 children presented to A&E over 30 days, of which 110 (58%) were admitted (m:f 54:56). 9% of those admitted were hypoxic (SpO2 <92%) and 86% had at least one severe sign on admission. Nebulised treatment was used in 25%. Mean (SD) initial heart rate and respiratory rate were no different in nebuliser vs. MDI groups (RR 45 (1.5) vs. 42(1.0); HR 155 (3.8) vs. 146 (2.1), p>0.05). Resolution of tachycardia and tachypnoea appeared to be delayed in those who received nebulisers. There was no difference in duration of admission between MDI and nebuliser groups.
Conclusions: In young children with acute wheeze, nebulised treatment did not lead to quicker resolution of symptoms. Nebulisers should therefore only be used in those with multiple severe symptoms. Further work is needed to determine a safe duration of observation after initial treatment before discharging home, in order to reduce unnecessary admission to hospital.
Footnotes
Cite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 666.
This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2020