Bronchodilator delivery in acute severe asthma in adults
- Report By: Stewart Teece - Research Fellow
- Search checked by Kevin Mackway-Jones - Consultant
- Institution: Manchester Royal Infirmary
- Current web editor: Minnie Alexander - Senior Information Officer
- Date Submitted: 1st March 2000
- Date Completed: 18th December 2000
- Last Modified: 21st March 2002
-
Status:
Green (complete)
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.([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.
Search Outcome
1734 papers found of which two were meta-analyses that included all other relevant papers.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Turner MO 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 |
| Cates C and 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 |
Comment(s)
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.References
- 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.