TOPLINE:

Among young children presenting to the emergency department (ED) with acute wheezing, those who received salbutamol via a valved holding chamber delivering a high drug dose had greater reductions in respiratory distress scores and lower hospitalization rates than those treated with a device delivering a lower dose, a trial found.

METHODOLOGY:

• Researchers conducted a multicenter randomized clinical trial and included 80 children aged 6-48 months who presented with moderate or severe acute wheezing (mean age, 23.1 months; 64% boys; Respiratory Distress Assessment Instrument [RDAI] score ≥ 6).
• Children were randomly assigned to receive salbutamol via two commercially available valved holding chambers (VHCs): Optichamber Diamond (VHC-1, high drug delivery performance in vitro) and Babyhaler (VHC-2, lower drug delivery performance in vitro), each used with its respective mask.
• The primary outcome was the posttreatment RDAI score, with the change in RDAI score from baseline also assessed. The study used an intention-to-treat analysis.
• Secondary outcomes included the rates of hospitalization and of requiring a fourth salbutamol dose in the ED, the posttreatment respiratory rate, and posttreatment oxygen saturation.

TAKEAWAY:

• Posttreatment mean RDAI scores were lower in children treated with VHC-1 than in those treated with VHC-2 (mean difference [MD], -4.1; P < .001), and the mean reduction in RDAI score from baseline was also greater (MD, -5.4; P < .001).
• The proportion of children requiring hospitalization was lower with VHC-1 than with VHC-2 (absolute difference, 30%; P = .005; number needed to treat, 3.3; P = .005; relative risk, [RR], 0.63).
• Following salbutamol treatment, the mean respiratory rate was lower with VHC-1 than with VHC-2 (MD, -5; P = .04), the mean oxygen saturation was higher (MD, 3%; P < .001 ), and the risk of requiring a fourth salbutamol dose was lower (RR, 0.72; P = .03).
• Even after adjustment for baseline severity, children treated with VHC-1 had lower posttreatment RDAI scores than those treated with VHC-2 (adjusted MD, -4.53 points; P < .001).

IN PRACTICE:

"Young children with acute wheezing experienced greater clinically significant improvement when salbutamol was administered through a VHC with high in vitro drug delivery compared with low in vitro drug delivery. This indicates that device choice matters and that guidelines should provide device-specific recommendations for pediatric inhalation therapy," the authors wrote.

SOURCE:

The study was led by Péter Csonka, MD, PhD, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. It was published online on February 23, 2026, in JAMA Pediatrics.

LIMITATIONS:

The study was limited by the inability to blind nurses and patients to the valved holding chamber devices because visual monitoring was required to ensure correct salbutamol administration; however, the primary outcomes were assessed by a blinded physician to reduce assessment bias. The findings applied specifically to the two VHC models tested and may not be generalizable to all commercially available devices. All participants were recruited in Finland, possibly limiting the generalizability of the findings to more diverse populations or low-income settings. In addition, formal patient or caregiver involvement was not included in the study design. Because the VHC delivering a lower dose was the most commonly used device locally, familiarity bias could have favored it.

DISCLOSURES:

The study was supported by grants from the Tampere Tuberculosis Foundation, the Research Foundation of Pulmonary Diseases, and Finnish State Research Funding from Oulu University Hospital, Finland. One author disclosed receiving grants from the Tampere Tuberculosis Foundation and the Research Foundation of Pulmonary Diseases during the conduct of the study. Another author disclosed receiving personal fees from ALK, AstraZeneca, Berlin Chemie, Boehringer Ingelheim, Chiesi, GSK, Orion Pharma, and Sanofi outside the submitted work and reported owning shares of Ausculthing Oy. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.