Oral versus inhaled bronchodilators in pediatric practice at a rural health care setting

Hippokratia 2006, 10(2):80-84

Ch Zavos, D Vini, J Kountouras, N Zavos, E Trivara
Dpt Pediatrics, Health Centre, Gonni, Larissa, Greece
2nd Medical Clinic Hippokratio General Hospital, Thessaloniki, Greece
Dpt Pediatrics, Infectious Diseases Hospital, Thessaloniki, Greece


The majority of pediatric asthma cases are managed entirely within general practice; selecting the appropriate type of therapy for the wheezy infant with no previous asthma history often becomes a dilemma for clinicians.
Aim: To compare the improvement in asthma exacerbations, after administration of oral or inhaled bronchodilator therapy, in children with newly diagnosed mild to moderate asthma.
Material and methods: A total of 128 children aged 6 months to 14 years with asthma symptoms were referred at a rural health care setting. Detailed case history was obtained and peak flow monitoring was performed when feasible. Group A, 58 children aged 2.94??2.57 years, received oral and Group B, 70 children aged 8.26??4.43 years, inhaled therapy. All children were re-examined 3 days and 7 days from onset of treatment.
Results: Improvement was noticed in 43/58 (74.1%) and 67/70 (95.7%) patients of groups A and B respectively (p?0.001) 3 and 7 days after the onset of treatment. Treatment was changed in 10 and 8 patients of each group respectively (p>0.05). Compliance was better in Group A (p?0.001). Fifty-two patients of Group B and no patients of Group A required further training (p?0.001). Inhaled bronchodilator therapy has led to a significant remission of asthma exacerbations compared to oral bronchodilator therapy.
Conclusions: Although there has been better compliance and no need for additional education in the patients receiving the oral therapy, the latter should be reserved only for children usually less than 2-3 years of age with mild occasional asthma, or for older children who seem not to be competent using the inhaled therapy on their first visit. Parents should be encouraged and trained to use inhaled rather than oral regimens in all age groups of children.

Keywords: asthma, oral therapy, inhaled bronchodilators, peak expiratory flow rate

Correspoding author: Zavos Ch, e-mail: czavos@hotmail.com