A Randomized Trial Comparing Metered Dose Inhalers and Breath Actuated Nebulizers

Snider, Mark; Wan, Jim Y.; Jacobs, Jonathan D.; R, Kink; Gilmore, Barry; Arnold, Sandra R.

doi:10.1016/j.jemermed.2018.03.002

Cited by 5 publications

(37 citation statements)

References 29 publications

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“…Finally, 15 studies were selected for inclusion in the meta‐analysis (Figure 1). Three new studies had been published since the above‐mentioned Cochrane systematic review on the topic published in 2013 11‐13 …”

Section: Resultsmentioning

confidence: 99%

“…Three studies were performed in the United States, 13,20,21 three in Thailand, 11,22,23 two in Canada, 24,25 and the remaining in other countries around the world 4,12,26‐30 . The oldest included study was published in 1993 24 and the most recent in 2018 13 . In general, the sample size of the included studies was small, with only five studies enrolling more than 100 children 13,20,21,28,29 …”

Section: Resultsmentioning

confidence: 99%

“…The oldest included study was published in 1993 24 and the most recent in 2018 13 . In general, the sample size of the included studies was small, with only five studies enrolling more than 100 children 13,20,21,28,29 …”

Section: Resultsmentioning

confidence: 99%

“…The majority of included studies (73.3%) enrolled children younger than 5 years of age 4,11‐13,20,21,26‐29 …”

Section: Resultsmentioning

confidence: 99%

“…Among all the included studies, four had a low risk of bias for all criteria assessed, 21,22,25,27 while six had a high risk of bias for blinding due to being open label trials, 4,12,13,20,29,30 and two had an unclear risk of bias in the blinding of participants and personnel 11,23 . Three studies had an unclear risk for selective reporting due to lack of clarity in reporting some outcomes of interest 11,26,30 .…”

Section: Resultsmentioning

confidence: 99%

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Metered‐dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta‐analysis

Payares-Salamanca

Contreras-Arrieta

Flórez-García

et al. 2020

Pediatric Pulmonology

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Objectives The benefits of metered‐dose inhalers with a spacer (MDI+S) have increasingly been recognized as an alternative method of albuterol administration for treating pediatric asthma exacerbations. The aim of this systematic review was to compare the response to albuterol delivered through nebulization (NEB) with albuterol delivered through MDI+S in pediatric patients with asthma exacerbations. Methods We conducted an electronic search in MEDLINE/PubMed, EMBASE, Ovid, and ClinicalTrials. To be included in the review, a study had to a randomized clinical trial comparing albuterol delivered via NEB versus MDI+S; and had to report the rate of hospital admission (primary outcome), or any of the following secondary outcomes: oxygen arterial saturation, heart rate (HR), respiratory rate (RR), the pulmonary index score (PIS), adverse effects, and need for additional treatment. Results Fifteen studies (n = 2057) met inclusion criteria. No significant differences were found between the two albuterol delivery methods in terms of hospital admission (relative risk, 0.89; 95% confidence interval [CI], 0.55–1.46; I2 = 32%; p = .65). There was a significant reduction in the PIS score (mean difference [MD], −0.63; 95% CI, −0.91 to −0.35; I2 = 0%; p < .00001), and a significantly smaller increase in HR (better; MD −6.47; 95% CI, −11.69 to −1.25; I2 = 0%; p = .02) when albuterol was delivered through MDI+S than when it was delivered through NEB. Conclusions This review, an update of a previously‐published meta‐analysis, showed a significant reduction in the PIS and a significantly smaller increase in HR when albuterol was delivered through MDI+S than when it was delivered through NEB.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The majority of included studies (73.3%) enrolled children younger than 5 years of age 4,11‐13,20,21,26‐29 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Metered‐dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta‐analysis

Payares-Salamanca

Contreras-Arrieta

Flórez-García

et al. 2020

Pediatric Pulmonology

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Asma infantile: gestione delle esacerbazioni in Pronto Soccorso

Masson-Rouchaud

2024

EMC - Urgenze

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From the infant to the geriatric patient—Strategies for inhalation therapy in asthma and chronic obstructive pulmonary disease

Hagmeyer

Koningsbruggen-Rietschel

Matthes

et al. 2023

Clinical Respiratory J

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Inhalation therapy represents the standard of care in children, adolescents as well as in young, middle‐aged and geriatric adults with asthma or chronic obstructive pulmonary disease. However, there are only few recommendations for the choice of inhalation devices, which consider both, age‐specific limitations in young and geriatric patients. Transition concepts are lacking. In this narrative review, the available device technologies and the evidence for age‐specific problems are discussed. Pressurized metered‐dose inhalers may be favoured in patients who fulfill all cognitive, coordinative and manual power requirements. Breath‐actuated metered‐dose inhalers, soft‐mist inhalers or the use of add‐on devices such as spacers, face masks and valved holding chambers may be suitable for patients with mild to moderate impairments of these variables. In these cases, available resources of personal assistance by educated family members or caregivers should be used to allow metered‐dose inhaler therapy. Dry powder inhalers may be reserved for patients with a sufficient peak inspiratory flow and good cognitive and manual abilities. Nebulizers may be indicated in persons who are either unwilling or unable to use handheld inhaler devices. After initiation of a specific inhalation therapy, close monitoring is essential to reduce handling mistakes. An algorithm is developed that considers age and relevant comorbidities to support the decision‐making process for the choice of an inhaler device.

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A Randomized Trial Comparing Metered Dose Inhalers and Breath Actuated Nebulizers

Cited by 5 publications

References 29 publications

Metered‐dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta‐analysis

Metered‐dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta‐analysis

Asma infantile: gestione delle esacerbazioni in Pronto Soccorso

From the infant to the geriatric patient—Strategies for inhalation therapy in asthma and chronic obstructive pulmonary disease

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