β-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: A systematic review with meta-analysis

Castro-Rodriguez, José A.; Rodrigo, Gustavo J.

doi:10.1016/j.jpeds.2004.04.007

Cited by 160 publications

(107 citation statements)

References 40 publications

(75 reference statements)

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“…A systematic review has shown that the delivery of inhaled b 2 -agonists by pMDI-S in acutely wheezy infants and preschool children is more effective than by nebuliser; recovery was quicker and the risk of hospital admission was reduced by 60% [138]. There are no studies comparing the two delivery devices for long-term management.…”

Section: Delivery Devicesmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

European Respiratory Journal

733

743

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There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis.Based on the limited evidence available, inhaled short-acting b 2 -agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop.Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

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Section: Delivery Devicesmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

European Respiratory Journal

733

743

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“…All SRs searched MEDLINE, 11 searched CENTRAL (17,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), and nine searched EMBASE (17)(18)(19)(20)(21)(22)(25)(26)(27)(28). Four or less searched AMED (17,19,20,22), PsycINFO (17,19,20,22), PubMed (23,25), and clinicaltrials.gov (19), and all Cochrane SRs searched the Cochrane Airways Group Specialized Register of Trials.…”

Section: Search Methods Used In the Included Srsmentioning

confidence: 99%

“…Four or less searched AMED (17,19,20,22), PsycINFO (17,19,20,22), PubMed (23,25), and clinicaltrials.gov (19), and all Cochrane SRs searched the Cochrane Airways Group Specialized Register of Trials. Common additional sources searched included the following: handsearching reference lists, journals, meeting abstracts, and/or conference proceedings (17)(18)(19)(20)(21)(22)(24)(25)(26)(27)(28)(29); and contacting authors, clinicians, collaborators, and/or drug companies (17-19, 21, 22, 24, 27, 29).…”

Section: Search Methods Used In the Included Srsmentioning

confidence: 99%

“…The included SRs provided outcome data relating to nine comparisons: SABA vs placebo (23), SABA vs SAAC (20), SABA vs adrenaline (26), SABA vs SABA (24), SABA and SAAC vs SABA alone (18,21,27), SABA and SAAC vs SAAC alone (20), SABA and MgSO 4 vs SABA alone (19,25), SABA delivered via MDI with spacer or VHC vs nebulizer (17,28,29), and SABA delivered by continuous vs intermittent nebulization (22). No SR provided data examining SAAC vs placebo.…”

Section: Interventions and Comparatorsmentioning

confidence: 99%

“…Eleven SRs provided data on hospital admission (17-20, 22-25, 27-29), four provided data on ED LOS (17,22,24,29), and no SRs provided data on ICU admission with or without ventilator support. Eight SRs provided data on vital signs (17,18,21,23,24,26,28,29), eight provided data on clinical severity scores (18,20,(22)(23)(24)(27)(28)(29), and nine provided data on adverse effects (17-20, 22, 24, 26, 27, 29). Nine SRs also provided data on pulmonary function (17-20, 22, 24, 25, 27, 29).…”

Section: Outcome Measuresmentioning

confidence: 99%

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Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

Pollock

Sinha

Hartling

et al. 2016

Allergy

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International guidelines provide conflicting recommendations on how to use bronchodilators to manage childhood acute wheezing conditions in the emergency department (ED), and there is variation within and among countries in how these conditions are managed. This may be reflective of uncertainty about the evidence. This overview of systematic reviews (SRs) aimed to synthesize, appraise, and present all SR evidence on the efficacy and safety of inhaled short-acting bronchodilators to treat asthma and wheeze exacerbations in children 0-18 years presenting to the ED. Searching, review selection, data extraction and analysis, and quality assessments were conducted using methods recommended by The Cochrane Collaboration. Thirteen SRs containing 56 relevant trials and 5526 patients were included. Results demonstrate the efficacy of short-acting beta-agonist (SABA) delivered by metered-dose inhaler as first-line therapy for younger and older children (hospital admission decreased by 44% in younger children, and ED length of stay decreased by 33 min in older children). Short-acting anticholinergic (SAAC) should be added to SABA for older children in severe cases (hospital admission decreased by 27% and 74% when compared to SABA and SAAC alone, respectively). Continuous nebulization, addition of magnesium sulfate to SABA, and levosalbutamol compared to salbutamol cannot be recommended in routine practice.Acute wheeze in children is one of the most common reasons for presentation to the emergency departments (ED) (1). In school-aged children, acute wheeze usually signifies underlying asthma, while in preschool children this sign may be the result of either asthma or viral-induced wheeze with distinct phenotypes and underlying mechanisms. In these age groups, regardless of the underlying pathology, exacerbations of recurrent wheeze and dyspnoea are largely caused by bronchoconstriction of the small airways. Although most children improve with bronchodilator therapy, many require hospital admission, and others may even require admission to critical or intensive care units. It is important, therefore, that children with wheeze and dyspnoea are treated promptly and appropriately in the ED to reduce symptoms and respiratory distress, mitigate hospital admission, and prevent respiratory failure. Across the UK and many other countries, there is a 10-fold difference in rates of hospital admission for acute asthma in children (2).Although the reasons for this are complex, one factor may be variations among EDs in the management of pediatric asthma, which have recently been described for key interventions such as inhaled bronchodilators (3).The three most common groups of inhaled bronchodilators used to treat acute asthma and wheeze in EDs are short-acting beta-agonists (SABA) such as salbutamol (albuterol), levosalbutamol (levalbuterol), and adrenaline (epinephrine); short-acting anticholinergics (SAACs) such as ipratropium bromide; and, more recently, a third category of muscle relaxants comprising magnesium sulfate (MgSO ...

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Data Extraction Errors in Meta-analyses That Use Standardized Mean Differences

Gøtzsche

Hróbjartsson²,

Maric³

et al. 2007

JAMA

161

153

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β-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: A systematic review with meta-analysis

Cited by 160 publications

References 40 publications

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

Data Extraction Errors in Meta-analyses That Use Standardized Mean Differences

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