Nebulizer delivery not better than metered-dose inhalers with spacer in adults or children

In acute asthma inhaled beta 2-agonists are often administered by nebuliser to relieve bronchospasm, but some have argued that metered-dose inhalers (MDI) with a holding chamber (spacer) can be equally effective. Nebulizers require a power source and need regular maintenance, and are more expensive in the community setting.

This Cochrane review included 1,897 children and 729 adults with asthma in 39 trials (33 trials in the emergency room and 6 trials on inpatients).

The method of delivery of beta 2-agonist did not show a significant difference in hospital admission rates. In adults, the risk ratio (RR) of admission for spacer versus nebulizer was 0.94. The risk ratio for children was 0.71.

In children, length of stay in the emergency department was significantly shorter when the spacer was used. Length of stay in the emergency department for adults was similar for the two delivery methods.

Peak flow and forced expiratory volume were also similar for the two delivery methods.

Nebulizer delivery produced outcomes that were not better than metered-dose inhalers (MDI) delivered by spacer in adults or children. Spacers may have some advantages compared to nebulizers for children with acute asthma.

The two methods (nebulizer vs. MDI) are shown in the videos below:

How to Use the Nebulizer Machine (albuterol, Xopenex, budesonide) - Demonstration Video. This video is an excerpt from the DVD Living With Asthma: A Guide to Controlling Your Asthma produced by St. Louis Children's Hospital:



How to Use a Nebulizer, from National Jewish Hospital: http://bit.ly/VCjfAp

How to Use a Metered Dose Inhaler (albuterol, Flovent, Symbicort, Dulera) - Demonstration Video. This video is an excerpt from the DVD Living With Asthma: A Guide to Controlling Your Asthma produced by St. Louis Children's Hospital:



References:

Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD000052. DOI: 10.1002/14651858.CD000052.pub3.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000052.pub3/abstract

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