Holding chambers versus nebulisers for beta-agonist treatment of acute asthma

Cates, Christopher J; Bara, Anna; Crilly, Jacqueline A; Rowe, Brian H.

doi:10.1002/14651858.cd000052

Cited by 129 publications

(111 citation statements)

References 45 publications

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“…64 For children and infants, a spacer with a face mask may be used. For all ages, oxygen, if available, should be administered between doses of β2-agonists.…”

Section: Treatment Of Acute Asthmamentioning

confidence: 99%

Summary of the 2008 BTS/SIGN British Guideline on the Management of Asthma

Levy

Thomas

Small

et al. 2009

Primary Care Respiratory Journal

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SummaryThe 2008 BTS/SIGN British Guideline on the management of asthma provides comprehensive updated evidence-based guidance on asthma management for healthcare professionals. This primary care-focussed summary has been produced to aid dissemination and implementation of the key guideline messages into primary care. The section on diagnosis emphasises the new integrated symptombased approach with clinicians using their deductive skills to determine the probability that the patient has asthma. The various tools used for monitoring asthma are discussed. There are sections on both non-pharmacological and pharmacological management of chronic asthma in adults and children. Treatment options for children are subdivided into the under-5s and children aged 5-12 years. Poor asthma control is manifested by exacerbations and acute asthma. Personalised asthma action plans for guided self management should be provided and used when levels of asthma control change. There are sections on difficult asthma and the treatment of exacerbations and acute severe asthma. Various outcome measures for auditing the quality of asthma care are discussed.

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“…64 For children and infants, a spacer with a face mask may be used. For all ages, oxygen, if available, should be administered between doses of β2-agonists.…”

Section: Treatment Of Acute Asthmamentioning

confidence: 99%

Summary of the 2008 BTS/SIGN British Guideline on the Management of Asthma

Levy

Thomas

Small

et al. 2009

Primary Care Respiratory Journal

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“…Because this is a topic of recent systematic reviews, [5][6][7] a MEDLINE search of English language publications since the last review was completed up to January 2005. No new study was found when the search was limited to randomized, placebocontrolled, double-blind clinical trials in children with acute asthma exacerbation in ED.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The trials compared administration of a short-acting β 2 agonist via a nebulizer or an MDI+VHC. 5 For the meta-analysis of ED studies, the primary outcome measure was rate of hospital admission. The relative risk ratio (RR) of hospital admission with MDI+VHC versus nebulizer did not differ in children (RR = 0.65, 95% CI: 0.4 to1.06) which was similar to the adult studies that were reviewed (RR = 0.88; 95% CI: 0.56 to 1.38).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Indeed, two recently published systematic reviews have concluded that delivery of short-acting β 2 agonists by MDI+VHC is at least as effective as delivery by nebulizer for the treatment of non life-threatening severe acute asthma exacerbations in children. 5,6 An additional systematic review with a meta-analysis found that in children under 5 years of age the use of an MDI+VHC was superior to nebulizer delivery of β 2 agonists for improving outcomes. 7 Response to an aerosolized β 2 agonist in severe acute asthma is dependent on the amount of drug delivered to the lung β 2 receptors, as well as the distribution of the aerosol throughout the conducting airways (site of bronchoconstriction).…”

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confidence: 99%

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MDI versus Nebulizers for Acute Asthma

Raissy

Kelly

2004

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVE: To evaluate studies comparing metered dose inhalers with holding chambers to nebulizers in the emergency department for the treatment of asthma exacerbation. DATA SOURCE: Primary articles and systematic review provided by the Cochrane Airways Review Group of the Cochrane Library identified by MEDLINE search (1966–February 2004) and through secondary sources. DATA SYNTHESIS: The Cochrane review included 21 randomized clinical trials conducted in hospital emergency departments comparing clinical outcomes following β2 agonist administration via a nebulizer or a metered dose inhaler with holding chamber. Although the relative risk ratio of hospital admission with metered dose inhaler and holding chamber did not differ in children or in adults compared to the nebulizer delivery, none of the individual studies reviewed were powered to detect a difference in the rate of hospital admission. Specific factors in the treatment of acute asthma such as assessment of severity, appropriate outcome selection, appropriate dose selection, and appropriate delivery systems need to be considered to critically evaluate the literature. CONCLUSION: Although available randomized clinical trials suggest equivalency of metered dose inhaler plus holding chambers and nebulized delivery of inhaled β2 agonists, these trials are biased to show no difference in response. There is no data to support the advantage of one method over the other in mild to moderate asthmatic patients either clinically or economically.

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“…Recentemente, Cates e colaboradores 28 avaliaram os efeitos do ID-espaçador comparados com os nebulizadores em pacientes com asma, incluindo o Grupo de CochraneVia Aérea, que compreendia 21 estudos até o ano de 2001 (880 crianças e 444 adultos), sem encontrar diferenças na taxa de hospitalização e nas provas de função pulmonar, sendo observada uma significativa menor freqüência cardí-aca nos pacientes que utilizaram ID-espaçador. Além disso, em um dos estudos pediátricos, observou-se uma taxa de permanência significativamente menor no grupo ID-espaçador.…”

Section: Terapia Inalatória Na Asma: Espaçadores Versus Nebulizadoresunclassified

Controversies in the pharmacological management of acute asthma in children

et al. 2002

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Objective: to present a review of controversial issues related to the pharmacological management of the treatment of acute asthma in children.Sources: articles published in national and international scientific journals. Data were selected from Lilacs and Medline databases.Summary of the findings: the article was organized into topics, presenting aspects on which there is consensus regarding the pharmacological treatment of asthma in children. Issues related to the use of metered dose inhaler versus nebulizers, the role of ß2-adrenergic drugs administered intravenously as well as the role of methylxanthine and magnesium sulfate are approached critically. Conclusions:Inhaled ß2-agonist drugs combined with corticosteroids remain the treatment of choice for acute episodes of asthma in children. Either nebulizers or metered dose inhalers connected to spacers are efficient for the relief of acute symptoms. Patients who are refractory to conventional treatment and develop severe acute asthma should receive ß2-agonist drugs intravenously, provided they are properly monitored. Methylxanthine and magnesium sulfate should be considered a second choice for selected patients.J Pediatr (Rio J) 2002; 78 (Supl.2): S151-S160: acute asthma, beta-agonist, magnesium sulfate, aminophylline. ResumoObjetivo: apresentar uma revisão acerca de questões controversas, relativas ao manejo farmacológico utilizado nos pacientes pediátricos portadores de asma aguda. Fontes dos dados: foram utilizadas informações de artigos publicados em revistas científicas nacionais e internacionais, selecionadas das bases de dados Lilacs e Medline.Síntese dos dados: o artigo foi estruturado em tópicos, apresentando aspectos consensuais no tratamento farmacológico da asma infantil. Questões relacionadas à utilização de inaladores dosimetrados versus nebulizadores, o papel das drogas ß 2 -adrenérgicas utilizadas pela via endovenosa, bem como das metilxantinas e do sulfato de magnésio, são abordados de maneira crítica.Conclusões: os ß 2 -agonistas administrados pela via inalatória, associados aos coricosteróides, permanecem o tratamento de eleição para episódios agudos de asma na população pediátrica. Tanto os nebulizadores quanto os inaladores dosimetrados, acoplados a espaçadores, são efetivos para alívio dos sintomas agudos. Pacientes refratários ao tratamento convencional, que evoluem para quadros de asma aguda grave, devem ter considerada a utilização de drogas ß 2 -agonistas pela via endovenosa, desde que adequadamente monitorizados. Quanto às metilxantinas e ao sulfato de magnésio, devem ser considerados alternativas secundárias para pacientes selecionados.J Pediatr (Rio J) 2002; 78 (Supl.2): S151-S160: asma aguda, beta-agonistas, sulfato de magnésio, aminofilina.

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Holding chambers versus nebulisers for beta-agonist treatment of acute asthma

Cited by 129 publications

References 45 publications

Summary of the 2008 BTS/SIGN British Guideline on the Management of Asthma

Summary of the 2008 BTS/SIGN British Guideline on the Management of Asthma

MDI versus Nebulizers for Acute Asthma

Controversies in the pharmacological management of acute asthma in children

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