Bronchodilator delivery in acute severe asthma in adults
Date First Published:
March 1, 2000
Last Updated:
March 21, 2002
Report by:
Stewart Teece, Research Fellow (Manchester Royal Infirmary)
Search checked by:
Kevin Mackway-Jones, Manchester Royal Infirmary
Three-Part Question:
In [an adult with acute severe asthma] is [delivery of bronchodilator therapy via nebuliser or spacer] better at [improving airflow and decreasing need for admission]?
Clinical Scenario:
A 24 year old known asthmatic is brought into the emergency department by friends. She has been in a smokey bar and has become very wheezy. You assess her asthma as severe. You wonder whether a nebuliser is necessary, or whether a spacer device will suffice.
Search Strategy:
Medline 1966-12/01 using the OVID interface.
Search Details:
([exp asthma OR asthma.mp] AND [exp bronchodilator agents OR bronchodilator$.mp] AND [exp nebulizers and vaporizers OR nebulise$.mp OR nebulize$.mp OR spacer$.mp]) LIMIT to human AND English language.
Outcome:
1734 papers found of which two were meta-analyses that included all other relevant papers.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Bronchodilator delivery in acute airflow obstruction. A meta-analysis. Turner MO, Patel A, Ginsburg S, et al. 1997, Canada | 12 of 18 randomised trials (507 patients) | Meta-analysis | Effect size | -0.02 (-0.2 to 0.16) | Includes 102 patients with COPD |
| Holding chambers versus nebulisers for beta-agonist treatment of acute asthma (Cochrane Review). Cates C J, Rowe BH. 2001, UK | 7 of 44 randomised trials (375 patients) | Systematic review | FEV1 | No significant difference | |
| PEFR | No significant difference | ||||
| Length of stay | No significant difference |
Author Commentary:
The two meta-analyses have 4 studies (199 patients) in common.
Bottom Line:
Spacer devices can be used in place of nebulisers in patients with acute severe asthma.
References:
- Turner MO, Patel A, Ginsburg S, et al.. Bronchodilator delivery in acute airflow obstruction. A meta-analysis.
- Cates C J, Rowe BH.. Holding chambers versus nebulisers for beta-agonist treatment of acute asthma (Cochrane Review).