A Cochrane review [Abstract] 1 included 39 studies (1 897 children and 729 adults). Thirty-three studies were conducted in the emergency room and equivalent community settings, and 6 studies were on inpatients with acute asthma (207 children and 28 adults).
This evidence summary deals with children. There was no significant difference in hospital admissions between metered-dose inhaler with spacer and nebuliser in administration of beta2-agonists in the treatment of acute asthma when treatments were repeated and titrated to the response of the participant (table T1). The length of stay in the emergency department was significantly shorter when the spacer was used. Peak flow and forced expiratory volume were similar for the two delivery methods. Pulse rate was lower for spacer in children as was the risk of developing tremor.
| Outcome | Relative effect (95% CI) | Assumed risk - nebuliser | Corresponding risk - spacer (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Hospital admission | RR 0.71 (0.47 to 1.08) | 110 per 1000 | 78 per 1000(52 to 119) | 757(9 studies) |
| Duration in emergency department (minutes) | The mean duration in emergency department in the control groups was 103 minutes | The mean duration in emergency department in the intervention groups was33 minutes shorter(43 minutes shorter to 24 minutes shorter) | 396 (3 studies) | |
| Final rise in FEV1 (% predicted) | The mean final rise in FEV1 in the control groups was 27% predicted at baseline | The mean final rise in FEV1 in the intervention groups was0.92% higher(4.96% lower to 6.79% higher) | 48 (2 studies) | |
| Rise in pulse rate (% baseline) | The mean rise in pulse rate in the control groups was7% rise from baseline | The mean rise in pulse rate in the intervention groups was5.62% lower(7.52% to 3.72% lower) | 670 (9 studies) | |
| Number of participants developing tremor | RR 0.64 (0.44 to 0.95) | 142 per 1000 | 91 per 1000(62 to 135) | 254(4 studies) |
Comment: The studies excluded people with life-threatening asthma, and the results of this meta-analysis should not be extrapolated to this patient population.
Primary/Secondary Keywords