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]?
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.
Medline 1966-12/01 using the OVID interface.
([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.
1734 papers found of which two were meta-analyses that included all other relevant papers.
|Author, date and country
||Study type (level of evidence)
|Turner MO et al,|
|12 of 18 randomised trials (507 patients)||Meta-analysis||Effect size ||-0.02 (-0.2 to 0.16)||Includes 102 patients with COPD|
|Cates C and Rowe BH,|
|7 of 44 randomised trials (375 patients)||Systematic review||FEV1||No significant difference |
|PEFR||No significant difference |
|Length of stay||No significant difference|
The two meta-analyses have 4 studies (199 patients) in common.
Clinical Bottom Line
Spacer devices can be used in place of nebulisers in patients with acute severe asthma.
- Turner MO, Patel A, Ginsburg S, et al. Bronchodilator delivery in acute airflow obstruction. A meta-analysis. Arch Int Med 1997;157(15):1736-44.
- Cates C J, Rowe BH. Holding chambers versus nebulisers for beta-agonist treatment of acute asthma (Cochrane Review). The Cochrane Library Issue 4, 2001. Oxford: Update Software.