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 adults. There was no significant difference between metered-dose inhaler with spacer and wet nebuliser in administration of beta2-agonists in the treatment of acute asthma when treatments were repeated and titrated to the response of the participant for the primary outcome of hospital admissions (table T1). Length of stay in the emergency department was similar for the two delivery methods. Peak flow and forced expiratory volume were also similar, and there was no difference in rise in pulse rate or number of participants developing tremor.
| Outcome | Relative effect (95% CI) | Assumed risk - nebuliser | Corresponding risk - spacer (chamber), 95% CI | Participants (studies) |
|---|---|---|---|---|
| Hospital admission | RR 0.94 (0.61 to 1.43) | 109 per 1000 | 103 per 1000(67 to 156) | 582 (9 studies) |
| Duration in emergency department (minutes) | The mean duration in emergency department in the control groups was109 minutes | The mean duration in emergency department in the intervention groups was2 minutes longer(23 minutes shorter to 27 longer) | 132 (2 studies) | |
| Final rise in FEV1 (% predicted) | The mean final rise in FEV1 in the control groups was22 % predicted FEV1 | The mean final rise in FEV1 in the intervention groups was0.96% higher(2.54 lower to 4.46 higher) | 307 (6 studies) | |
| Rise in pulse rate (% baseline) | The mean rise in pulse rate in the control groups was-2% of baseline | The mean rise in pulse rate in the intervention groups was1.23 lower(4.06 lower to 1.6 higher) | 376 (7 studies) | |
| Number of participants developing tremor | RR 1.12 (0.66 to 1.9) | 185 per 1000 | 207 per 1000(122 to 351) | 234(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