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Evidence summaries

Holding Chambers (Spacers) Versus Nebulisers for Beta-Agonist Treatment of Acute Asthma in Adults

Metered-dose inhalers with spacer perform at least as well as nebulisers for delivering beta2-agonist drugs in acute asthma in adults. Level of evidence: "A"

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.

Multiple treatment of beta2-agonist via spacer (chamber) compared to nebuliser for adults with acute asthma

OutcomeRelative effect (95% CI)Assumed risk - nebuliserCorresponding risk - spacer (chamber), 95% CIParticipants (studies)
Hospital admissionRR 0.94 (0.61 to 1.43)109 per 1000103 per 1000(67 to 156)582 (9 studies)
Duration in emergency department (minutes) The mean duration in emergency department in the control groups was109 minutesThe 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 FEV1The 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 baselineThe 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 tremorRR 1.12 (0.66 to 1.9)185 per 1000207 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.

    References

    • Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev 2013;(9):CD000052. [PubMed]

Primary/Secondary Keywords