Article type
Year
Abstract
Introduction: To compare holding chambers and wet nebulisation for the delivery of beta-agonists in the treatment of acute asthmatic exacerbations.
Methods: Randomised controlled trials (RCTs) were identified using the Cochrane Airways Review Group database. All RCTs involving adults and/or children (from 2 years of age), where wet nebulisation and holding chambers were compared for beta-agonist delivery in acute asthma in the community or hospital emergency department (ED). Outcome measures included: admission to hospital, duration in the ED, change in respiratory rate, blood gases, pulse rate, tremor, symptom score and lung function. Data was extracted by a single reviewer (CJC). Missing data. (e.g. standard deviation for changes in lung function) were obtained from authors or estimated. Sensitivity analyses were performed to determine the impact of including estimated results. The data was analysed using the Cochrane Review Manager (2.1 a).
Results: 112 abstracts were identified; of these 44 were potentially relevant and were selected for detailed examination of the full paper. The review was confined to 12 articles, which met the inclusion criteria. No significant difference was found in hospital admission rate, {odds ratio (OR) = 0.98; 95% confidence interval (Cl): 0.55 to 1.8.}. Significant differences were demonstrated in other outcomes, with holding chambers resulting in less time spent in the ED {weighted mean difference (WMD) = -0.48 hours; 95% CI: -0.68 to -0.28 hours}, less deterioration of blood gases {OR = 0.38; 95% CI: 0.19 to 0.78}, and lower pulse rates {WMD = -4.60% baseline; 95% CI: -7.1 to -2.1% baseline}.
Discussion: Metered-dose inhalers with holding chamber produce outcomes that were at least as good as nebulisers in the delivery of beta-agonists in acute asthma. Side effects may be more pronounced with nebulisers (especially in children).
Methods: Randomised controlled trials (RCTs) were identified using the Cochrane Airways Review Group database. All RCTs involving adults and/or children (from 2 years of age), where wet nebulisation and holding chambers were compared for beta-agonist delivery in acute asthma in the community or hospital emergency department (ED). Outcome measures included: admission to hospital, duration in the ED, change in respiratory rate, blood gases, pulse rate, tremor, symptom score and lung function. Data was extracted by a single reviewer (CJC). Missing data. (e.g. standard deviation for changes in lung function) were obtained from authors or estimated. Sensitivity analyses were performed to determine the impact of including estimated results. The data was analysed using the Cochrane Review Manager (2.1 a).
Results: 112 abstracts were identified; of these 44 were potentially relevant and were selected for detailed examination of the full paper. The review was confined to 12 articles, which met the inclusion criteria. No significant difference was found in hospital admission rate, {odds ratio (OR) = 0.98; 95% confidence interval (Cl): 0.55 to 1.8.}. Significant differences were demonstrated in other outcomes, with holding chambers resulting in less time spent in the ED {weighted mean difference (WMD) = -0.48 hours; 95% CI: -0.68 to -0.28 hours}, less deterioration of blood gases {OR = 0.38; 95% CI: 0.19 to 0.78}, and lower pulse rates {WMD = -4.60% baseline; 95% CI: -7.1 to -2.1% baseline}.
Discussion: Metered-dose inhalers with holding chamber produce outcomes that were at least as good as nebulisers in the delivery of beta-agonists in acute asthma. Side effects may be more pronounced with nebulisers (especially in children).