SynthesisThe Cochrane database of systematic reviews2000
Holding chambers versus nebulisers for beta-agonist treatment of acute asthma.
Synthesis in The Cochrane database of systematic reviews, 2000. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
5 citing papers in PubMed, 149 citations in OpenAlex.
- The Differences in Acute Management of Asthma in Adults and Children.Frontiers in pediatrics · 2019Review
- Management of children with severe asthma exacerbation in the emergency department.Paediatric drugs · 2002Review
- Oxygen treatment for acute severe asthma. Home oxygenation would be more effective.BMJ (Clinical research ed.) · 2001Article
- Hold it! Correct use of inhalers in children with asthma.The Western journal of medicine · 2001Article
- Acute asthma.BMJ (Clinical research ed.) · 2001Review
Corrections and comments
- Updated by
Authors and funding
2 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn acute asthma inhaled beta-agonists are often administered to relieve bronchospasm by wet nebulisation, but some have argued that metered-dose inhalers with a holding chamber (spacer) can be equally effective. In the community setting nebulisers are more expensive, require a power source and need regular maintenance.
objectivesThere is controversy as to whether wet nebulisers are better than metered dose inhalers with holding chambers to deliver beta2-agonist medications for acute asthma. Comparisons of hospital and home use are also of interest. The objective of this review was to assess the effects of holding chambers compared to nebulisers for the delivery of beta2-agonists for acute asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials in adults and children (from two years of age) with asthma, where holding chamber beta2-agonist delivery was compared with wet nebulisation. DATA COLLECTION AND ANALYSIS: One reviewer applied study inclusion criteria and extracted the data. Trial quality was assessed independently by two reviewers. Missing data were obtained from the authors or estimated. MAIN
resultsThis review analysed 686 children and 375 adults included in 16 trials. Method of delivery of beta2-agonist did not appear to affect hospital admission rates. In adults, the odds ratio of holding chamber versus nebuliser was 1.12, 95% confidence interval 0.45 to 2.76. The odds ratio for children was 0.91, 95% confidence interval 0.4 to 2.1. Children's length of stay in the emergency department was significantly shorter when the holding chamber was used, with a weighted mean difference of -0.62 hours, 95% confidence interval -0.84 to -0.40 hours. Adults' length of stay in the emergency department was similar for the two delivery methods. Peak flow and forced expiratory volume were also similar for the two delivery methods. Pulse rate was lower for holding chamber in children, weighted mean difference -8.3% baseline, 95% confidence interval -11.5 to -5.0,. REVIEWER'S
conclusionsMetered-dose inhalers with holding chamber produced outcomes that were at least equivalent to nebuliser delivery. Holding chambers may have some advantages compared to nebulisers for children with acute asthma.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.