Salbutamol via Inhaler Effective and Safer than Nebulisation in Pediatric Asthma: Study Finds

"Children under the age of six who were treated with pMDIs experienced notably better outcomes, including higher hospital discharge rates (98.1% vs. 76.9%), fewer hospital admissions, shorter stays in the emergency department (1.7 vs. 4.0 hours), and required lower doses of salbutamol (0.10 vs. 0.81 mg/kg), along with fewer treatment-related side effects," the researchers reported.

Conducted over eight months across two centres, the study compared the effectiveness of salbutamol administration through pMDIs and nebulisers in children presenting to paediatric emergency departments (PED) with asthma flare-ups. Clara Lemaçon and Anne-Aurélie Lopes from Paris University, Paris, evaluated outcomes such as hospitalisation rates, time spent in the emergency department, salbutamol dosage required, and the incidence of side effects.

Based on the study, the researchers reported the following findings:

• The study included 384 children, primarily with mild or moderate asthma exacerbations.
• Overall discharge rates were similar between pMDI (82.7%) and nebulisation (81.6%).
• Among children under six years, pMDI led to a significantly higher discharge rate (98.1%) compared to nebulisation (76.9%).
• Hospitalisation rates were lower in the pMDI group than in the nebulised group.
• Children treated with pMDI had shorter emergency department stays (1.7 hours) compared to those who received nebulisation (4.0 hours).
• The required dose of salbutamol was significantly lower in the pMDI group (0.10 mg/kg) than in the nebulisation group (0.81 mg/kg).
• The pMDI group used less ipratropium and oral corticosteroids.
• Fewer treatment-related side effects were observed with pMDI use.
• The need for supplemental oxygen was lower in children receiving pMDI, particularly in those under six years of age.

The authors noted that while nebulisation has traditionally been the go-to method for acute asthma management in children, these findings strengthen the case for broader adoption of pMDIs with spacers in emergency settings. The comparable effectiveness, coupled with lower drug exposure and fewer side effects, makes it a safer and more efficient choice, especially for younger children.

“The use of pMDIs not only ensures clinical outcomes on par with nebulisers but also helps reduce hospital admissions and medication side effects,” the researchers stated. They also emphasised the importance of training children and caregivers in proper pMDI use, which could contribute to lowering emergency visits for asthma attacks in the long term.

"This study adds to a growing body of evidence supporting the use of pMDIs as a frontline treatment for paediatric asthma exacerbations, potentially prompting a shift in emergency care protocols for children with respiratory issues," the researchers concluded.

Reference:

Lemaçon, C., & Lopes, A. (2025). Inhalers or nebulisation of salbutamol in childhood asthma exacerbations in emergency departments. Respiratory Medicine, 108152. https://doi.org/10.1016/j.rmed.2025.108152