CQ6 Are pMDIs with spacers more effective than nebulizers in the multiple-dose inhalation of beta2-agonists for treating acute asthma exacerbation in children?

Abstract

 Background : A systemic review (SR) was performed to compare the effect of pMDIs with spacers to that of nebulizers in the delivery of short-acting beta2-agonists (SABAs) in the treatment of acute asthma exacerbation.

 Methods : Randomized controlled trials (RCTs) comparing the pMDI with spacers and nebulizers used for the inhalations of SABAs in patients under 20 years of age with acute asthma exacerbation in the emergency department (ED) were selected. The primary outcome was hospital admission after multiple inhalations of SABAs.

 Results : A total of 26 RCTs (30 references) were selected from a previous SR, and none were selected from an additional search. The primary outcome was analyzed from nine studies (363 children), and the risk ratio of the using pMDI with spacers to that using nebulizers was 0.71 (95% confidence interval 0.47～1.08, p=0.11). The time spent in the ED was significantly shorter using spacers than using nebulizers. The rise in pulse rate (% baseline) and frequency of tremors were significantly lower using spacers than using nebulizers.

 Conclusion : The effect of multiple inhalations of SABAs using pMDI with spacers was not different from that of inhalations using nebulizers in children with acute asthma. Further studies using a Japanese usual dose of SABAs in a Japanese population are required.