COMPARISON OF TWO INHALATIONAL TECHNIQUES FOR BRONCHODILATOR ADMINISTRATION IN CHILDREN AND ADOLESCENTS WITH ACUTE ASTHMA CRISIS: A META-ANALYSIS

Cristian Roncada, Julia Andrade, Luísa Carolina Bischoff, Paulo Márcio Pitrez, Cristian Roncada, Julia Andrade, Luísa Carolina Bischoff, Paulo Márcio Pitrez

Abstract

Objective: To compare the efficacy of pediatric asthma treatment by nebulizer and metered-dose inhaler with the use of a spacer (MDI-spacer) in rescue techniques for asthmatic patients assisted at pediatric emergency units.

Data sources: A systematic review was conducted to identify the most relevant randomized controlled trials comparing the administration of a bronchodilator (β-2 agonist) by two inhalation techniques (nebulization and MDI-spacer) to treat asthma in children at pediatric emergency units. The following databases were searched: PubMed, Scientific Electronic Library Online (SciELO), and ScienceDirect. Two researchers independently applied the eligibility criteria, and only randomized controlled trials that compared both inhalation techniques (nebulization and MDI-spacer) for asthma treatment at pediatric emergency units were included.

Data synthesis: 212 articles were pre-selected, of which only nine met the eligibility criteria and were included in meta-analysis. Results show no differences between inhalation techniques for any of the four outcomes analyzed: heart rate (difference - Df: 1.99 [95% confidence interval - 95%CI -2.01-6.00]); respiratory rate (Df: 0.11 [95%CI -1.35-1.56]); O2 saturation (Df: -0.01 [95%CI -0.50-0.48]); and asthma score (Df: 0.06 [95%CI -0,26-0.38]).

Conclusions: The findings demonstrate no differences in cardiorespiratory frequency, O2 saturation, and asthma scores upon administration of β-2 agonist by both inhalation techniques (nebulization and MDI-spacer) to asthmatic patients assisted at pediatric emergency units.

Conflict of interest statement

Conflict of interests: The authors declare no conflict of interests.

Figures

Figure 1:. Study design and selection of…
Figure 1:. Study design and selection of articles.
Figure 2:. Difference between heart (A) and…
Figure 2:. Difference between heart (A) and respiratory (B) rates according to nebulization techniques and the use of MDI-spacer.
Figure 3:. Difference between O2 saturation (A)…
Figure 3:. Difference between O2 saturation (A) and asthma score (B) according to nebulization techniques and the use of MDI-spacer.

References

    1. Solé D, Camelo-Nunes IC, Wandalsen GF, Mallozi MC. Asthma in children and adolescents in Brazil: contribution of the International Study of Asthma and Allergies in Childhood (ISAAC) Rev Paul Pediatr. 2014;32:114–125.
    1. Ring J, Akdis C, Lauener R, Schäppi G, Traidl-Hoffmann C, Akdis M. Global Allergy Forum and Second Davos Declaration 2013 Allergy: Barriers to cure-challenges and actions to be taken. Allergy. 2014;69:978–982.
    1. Wijga AH, Zuidgeest MG, Kerkhof M, Koppelman GH, Smit HA, Jongste JC. Guideline-recommended use of asthma medication by children is associated with parental information and knowledge: the PIAMA birth cohort. Pharmacoepidemiol Drug Saf. 2014;23:406–410.
    1. Pijnenburg MW, Szefler S. Personalized medicine in children with asthma. Paediatr Respir Rev. 2015;16:101–107.
    1. Bisgaard H, Szefler S. Prevalence of asthma-like symptoms in young children. Pediatr Pulmonol. 2007;42:723–728.
    1. Global Initiative for Asthma Global Strategy for Asthma Management and Prevention. 2016. [2017 Feb 27]. homepage on the Internet. Available from:
    1. Castro-Rodriguez JA, Rodrigo GJ. A systematic review of long-acting beta2-agonists versus higher doses of inhaled corticosteroids in asthma. Pediatrics. 2012;130:e650–e657.
    1. Brannan JD, Lougheed MD. Airway hyperresponsiveness in asthma: mechanisms, clinical significance, and treatment. Front Physiol. 2012;3:460–460.
    1. Yilmaz O, Bakirtas A, Ertoy Karagol HI, Topal E, Demirsoy MS. Allergic rhinitis may impact the recovery of pulmonary function tests after moderate/severe asthma exacerbation in children. Allergy. 2014;69:652–657.
    1. Zamboni A, Thommazo A, Hernandes E, Fabbri SC, editors. StArt Uma Ferramenta Computacional de Apoio à Revisão Sistemática; Proceedings of the Congresso Brasileiro de Software (CBSoft'10); 2010 Sep 27-Oct 1; Salvador, Brazil. 2010.
    1. Collaboration Cochrane Review Manager (RevMan) Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2011. Computer program.
    1. Batra V, Sethi GR, Sachdev HP. Comparative efficacy of jet nebulizer and metered dose inhaler with spacer device in the treatment of acute asthma. Indian Pediatr. 1997;34:497–503.
    1. Chong HJ, Neto, Chong-Silva DC, Marani DM, Kuroda F, Olandosky M, Noronha L. Different inhaler devices in acute asthma attacks: a randomized, double-blind, placebo-controlled study. J Pediatr (Rio J) 2005;81:298–304.
    1. Delgado A, Chou KJ, Silver EJ, Crain EF. Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department. Arch Pediatr Adolesc Med. 2003;157:76–80.
    1. Benito-Fernandez J, Gonzalez-Balenciaga M, Capape-Zache S, Vazquez-Ronco MA, Mintegi-Raso S. Salbutamol via metered-dose inhaler with spacer versus nebulization for acute treatment of pediatric asthma in the emergency department. Pediatr Emerg Care. 2004;20:656–659.
    1. Jamalvi SW, Raza SJ, Naz F, Shamim S, Jamalvi S. Management of Acute Asthma in children using metered dose in inhaler and small volume nebulizer. J Pakistan Med Assoc. 2006;56:595–599.
    1. Kerem E, Levison H, Schuh S, O'Brodovich H, Reisman J, Bentur L, et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. J Pediatr. 1993;123:313–317.
    1. Leversha AM, Campanella SG, Aickin RP, Asher MI. Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma. J Pediatr. 2000;136:497–502.
    1. Sannier N, Timsit S, Cojocaru B, Leis A, Wille C, Garel D. Traitement aux urgences des crises d'asthme par nébulisations vs chambres d'inhalation. Arch. Pédiat. 2006;13:238–244.
    1. Vilarinho L, Mendes CM, Souza L. Metered-dose inhalers with home-made spacers versus nebulizers to treat moderate wheezing attacks in children. J Pediatr (Rio J) 2003;79:403–412.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa