Holding chambers versus nebulisers for beta-agonist treatment of acute XXXX .

@entity2263 @entity565 @entity1 @entity5143
BACKGROUND: In acute @entity565 inhaled beta-agonists are often administered to relieve @entity5143 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. OBJECTIVES: There is controversy as to whether wet nebulisers are better than metered dose inhalers with holding chambers to deliver @entity2263 -agonist medications for acute @entity565 . 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 @entity2263 -agonists for acute @entity565 . SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials in adults and @entity1 (from two years of age) with @entity565 , where holding chamber @entity2263 -agonist delivery was compared with wet nebulisation. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied study inclusion criteria (one reviewer for the first version of the review), extracted the data and assessed trial quality. Missing data were obtained from the authors or estimated. MAIN RESULTS: This review has been updated in 2001 to include 4 new trials and has now analysed 880 @entity1 and 444 adults included in 21 trials. Method of delivery of @entity2263 -agonist did not appear to affect hospital admission rates. In adults, the relative risk of admission for holding chamber versus nebuliser was 0.88 (95% confidence interval 0.56 to 1.38). The relative risk for @entity1 was 0.65 (95% confidence interval 0.4 to 1.06). One study in @entity1 found a significantly shorter length of stay in the emergency department 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 @entity1 , weighted mean difference -7.8% baseline (95% confidence interval -10.2 to -5.3). REVIEWER'S CONCLUSIONS: Metered-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 @entity1 with acute @entity565 .
