Comparative study of rotahaler with metered dose inhaler in administering salbutamol in children with bronchial asthma

Balaji M. D., Rugmini Kamalammal


Background: It is estimated that around 300 million people suffer from asthma and the burden of this disease to families and patients is increasing worldwide. Reliver inhalations are the mode of management in acute exacerbation of asthma. Children of age 6-12 years can use both rotahaler and metered dose inhalers. This study compares the effectiveness of these two modalities in administration of salbutamol in acute exacerbation of asthma.

Methods: A prospective study among 200 children with acute exacerbation of bronchial asthma in children in 6 to 12 years of age having mild to moderate persistent asthma. Acute exacerbation was defined as PEFR of <80% of the predicted value, children were randomly allotted to two groups and were administered salbutamol either by rotahaler or by metered dose inhaler. PEFR was measured before and after administration of 200 µg of salbutamol and reversibility of bronchoconstriction was statistically analyzed.

Results: Mean increase in percentage of PEFR value after giving therapy was found to be 19.82 with SD -3.42, 21.9 with SD - 5.99, 20.61 with SD - 3.43, 21.31 with SD - 3.5 in rotahaler (Mild) group, rotahaler (Moderate) group, metered dose inhaler (Mild) group, Metered Dose Inhaler (Moderate) group respectively There was no statistically significant advantage of one modality over the other.

Conclusions: Rapid relief of airway obstruction can be achieved in acute exacerbation of asthma by both the devices namely rotahaler and metered dose inhaler.


PEFR, MDI, Rotahaler, Acute Exacerbation, Asthma

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Pocket guide for asthma management and prevention in children 5 years and younger GINA. Available at Management-and-Prevention-in-Children-5-Years- and-Younger. Accessed on 19 July 2015.

Global Burden of Asthma GINA. Available from: Accessed on 19 July 2015.

Eder W, Ege MJ, von Mutius E. The asthma epidemic. N Engl J Med. 2006;355(21):2226-35.

Paramesh DH. Epidemiology of asthma in India. Indian J Pediatr. 2002;69(4):309-12.

National heart, lung, and blood institute, national asthma education program expert panel. Guidelines for the diagnosis and management of asthma. J Allergy Clin Immunol. 1991;88:425-534.

Kendrick AH, Higgs CM, Whitfield MJ, Laszlo G. Accuracy of perception of severity of asthma; patients treated in general practice. BMJ. 1993;126:825-8.

Sly PD, Cahill P, Willet K, Burton P. Accuracy of mini peak flow meters in indicating changes in lung function in children with asthma. BMJ. 1994;308:572-4.

Gibson PG, Wong BJ, Hepperle MJ, Kline PA, Girgis-Gabardo A, Guyatt G, et al. A research method to induce and examine a mild exacerbation of asthma by withdrawal of inhaled corticosteroid. Clin Exp Allergy. 1992;22:525-32.

Beasley R, Cushley M, Holgate ST. A self-management plan in the treatment of adult asthma. Thorax. 1989;44:200-4.

Hetzel MR, Clark TJ, Branthwaite MA. Asthma; analysis of sudden deaths and ventilatory arrests in hospital. BMJ. 1977;1:808-1.

Connolly CK, Chan NS. Relationship between different measurements of respiratory function in asthma. Respiration. 1987;52:22-33.

Nowak RM, Pensier MI, Sarkar DD, Anderson JA, Kvale PA, Ortiz AE et al. Comparison of peak expiratory flow and FEV1 admission Nowak criteria for acute bronchial asthma. Ann Emerg Med. 1982;11:64-9.

Cherniack RM, Chatbum R, Gardner RM, Katz RM, Malveaux FJ, Sander N et al. Statement on technical standards for peak flow meters. bethesda (MD). National institutes of health, 1992. Publication number:NIH 92-2113a.

Gardner RM, Carpo RO, Jackson BR, Jensen RL. Evaluation of accuracy and reproducibility of peak flow meters at 1,400 m. Chest. 1992;101:948:52.

Van Schayck, CP, Dompelling E, Ven Weel C, Folgering H, van den Hoogen HJ. Accuracy and reproducibility of the assess peak flow meter. Eur Respir J. 1990;3:338-41.

Balasubramanian S, Ravikumar NR, Elavanzhagan C, Shivabalan SO. Peak expiratory flow rates in children- a ready reckoner. Indian pediatr. 2002:39:104-6.

Swaminathan S, Venkatesan P, Mukunthan R. Peak expiratory flow rate in South Indian children. Indian Pediatr. 1993;30:207-10.

Hsu KHK, MD, Jenkins DE, Hsi BP. J Pediatr. 1979;95:192-6.

Godfrey S, Kamburoff PL, Nairn JR. Spirometry, lung volumes and airway resistance in normal children aged 5 to 18 years. Br J Dis Chest. 1970;64:15-4.

Bronsky EA, Bucholtz GA, Busse WW. Comparison of inhaled salbutamol powder and aerosol in Asthma. J Allergy Clin Immunol. 2004;79:741-2.

Lodha R, Gaurav G, Bedanta PB, Nagpal R, Kabra SK. Metered dose inhaler with spacer versus dry powder inhaler for delivery of salbutamol in acute exacerbation of asthma; a randomized controlled trial. Indian Pediatr. 2004;41:15-20.

Golish J, McCarthy K. Albuterol delivered by MDI, MDI + spacer and rotahaler device - a comparison of efficacy and safety. J Asthma. 1998;35:373-9.

O’Callaghan C, Everard ML, Bush A, Hiller EJ, Russell RR, Keefe OP, et al. Salbutamol dry powder inhaler: efficacy, tolerability and acceptability study. Pediatr Pulmonol. 2002;33:189-93.

Bronsky EA, Spector SL, Perlman D S. Albuterol aerosol versus rotacaps in exercised induced bronchospasm. J Asthma. 1995;32:207-214.

Khaled SM, Akter F, Rahman K, Mohammad SU, Rahman HM. Bronchodilator response to salbutamol delivered by metered dose inhaler with spacer and dry powder inhaler in acute asthma in children: a comparative study. Bangladesh J Child Health. 2014;38(2):63.