Titolo del documento

Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children.

Autori e Nazionalità

Rodriguez C, Sossa M, Lozano J

Fonte bibliografica

Cochrane Database Syst Rev 2008; apr 16:(2):CD005536.

Lingua

Inglese

Abstract

BACKGROUND: Strong evidence supports the use of metered-dose inhalers combined with a spacer for delivering rapid-acting inhaled beta-2 agonists in the treatment of acute exacerbations of asthma in children. The high cost and lack of availability of commercially produced spacers however, have limited their use in developing countries. OBJECTIVES: The aim of this review was to compare the response to inhaled beta-2 agonists delivered through metered-dose inhaler using home-made spacers, to the use of commercially produced spacers, in children with acute exacerbations of wheezing or asthma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library Issue 3, 2007,(up to August 2007) MEDLINE , EMBASE, CINHAL, LILACS and reference lists of included studies. We contacted authors and known experts in the field, and approached pharmaceutical companies that manufacture inhalation spacers to identify additional published or unpublished data. No language restrictions were applied. SELECTION CRITERIA: Trials comparing treatment with rapid acting beta 2-agonists delivered though MDI attached to home-made spacers, with the same bronchodilator therapy delivered with MDI and commercially produced spacers, in children under 18 years with acute exacerbations of wheezing or asthma. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted the data and assessed trial quality. Missing data were obtained from the authors or estimated from information available in published reports. MAIN RESULTS: Six trials with 658 participants met the inclusion criteria . At the time of this report, five trials were published in full text, and one study was available in abstract form only. No significant differences were demonstrated between the two delivery methods in terms of need for hospital admission (RR 1.00, 95% CI 0.63 to 1.59), change in oxygen saturation (SMD -0.03, 95% CI -0.39 to 0.33), PEFR (SMD 0.04, 95% CI -0.72 to 0.80), clinical score (WMD 0.00, 95% CI -0.37 to 0.37), in terms of need for additional treatment (RR 1.18, 95% CI 0.84 to 1.65), or regarding change in heart rate per minute (SMD 0.09, 95% CI -0.24 to 0.42). AUTHORS' CONCLUSIONS: Overall, this review supports did not identify a difference between these two methods for delivering bronchodilator therapy to children with acute asthma or lower airways obstruction attacks. Care should be taken in the interpretation and applicability of our results because of the small number of RCTs along with few events available meeting the criteria for inclusion in the review, absence of the primary outcome of interest and other clinically important outcomes in the majority of included studies. The possible need for a face-mask in younger children using home-made spacers should also be considered in practice.

PMID

PMID: 18425921 [PubMed - in process]

Tipo di studio

Revisione Sistematica con metaanalisi

Livello di efficacia

1+

Commento

6 studi con 658 bambini dimostrano che non esistono differenze nel somministrare i broncodilatatori tramite distanziatori commerciali vs quelli fatti in casa per quanto riguarda i ricoveri in ospedale, le modifiche della saturazione di ossigeno, del PEFR, dello score clinico, , della necessità di ulteriore trattamento, della modifiche della frequenza cardiaca.

Titolo del documento

Inadequate skill of healthcare professionals in using asthma inhalation devices 

Autori e Nazionalità

Self TH, Arnold LB, Czosnowsky LM, Swanson JM, Swanson H. USA

Fonte bibliografica

J Asthma 2007;44:593-598 

Lingua

Inglese

Abstract

Inadequate skill in the use of asthma inhalation devices by healthcare professionals has been well documented over the past 25 years. We performed a PubMed search of the English literature for studies regarding skill by physicians, medical students, pharmacists, nurses, and respiratory therapists in using asthma inhalation devices. This review summarizes 20 studies that were identified. Results of these studies consistently showed lack of skill in using metered-dose inhalers, spacers, and dry powder inhalers by a majority of healthcare professionals. National and international guidelines for asthma management include detailed patient education as an essential component of care, yet a large percentage of healthcare professionals are not competent in using inhalation devices. Practical solutions to this problem are needed to enhance

PMID

PMID: 17943567 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione

Livello di evidenza

2+

Commento

Questa Revisione ha preso in esame i 20 studi che analizzano le competenze di medici, infermieri, farmacisti e terapisti respiratori riguardo i distanziatori e gli erogatori di polvere secca. Queste figure professionali hanno scarsa conoscenza della tecnica inalatoria, in questo articolo vengono anche proposti dei suggerimenti per migliorare questa situazione. 

Titolo del documento

Holding chambers (spacers) versus nebulisers for beta-agonists treatament of acute asthma

Autori e Nazionalità

Cates CJ, Crilly JA, Rowe BH. Gran Bretagna

Fonte bibliografica

Cochrane Database Syst Rev 2006 apr 19;(2):CD000052

Lingua

Inglese

Abstract

BACKGROUND: In acute asthma inhaled beta2-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. Nebulisers require a power source and need regular maintenance, and are more expensive in the community setting. OBJECTIVES: To assess the effects of holding chambers (spacers) compared to nebulisers for the delivery of beta2-agonists for acute asthma. SEARCH STRATEGY: We last searched the Cochrane Airways Group trials register in January 2006 and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2005). SELECTION CRITERIA: Randomised trials in adults and children (from two years of age) with asthma, where spacer beta2-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. Results are reported with 95% confidence intervals (CI). MAIN RESULTS: This review has been updated in January 2006 and four new trials have been added. 2066 children and 614 adults are now included in 25 trials from emergency room and community settings. In addition, six trials on in-patients with acute asthma (213 children and 28 adults) have been reviewed. Method of delivery of beta2-agonist did not appear to affect hospital admission rates. In adults, the relative risk of admission for spacer versus nebuliser was 0.97 (95% CI 0.63 to 1.49). The relative risk for children was 0.65 (95% CI: 0.4 to 1.06). In children, length of stay in the emergency department was significantly shorter when the spacer was used, with a mean difference of -0.47 hours (95% CI: -0.58 to -0.37). Length of stay in the emergency department for adults 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 spacer in children, mean difference -7.6% baseline (95% CI: -9.9 to -5.3% baseline). AUTHORS' CONCLUSIONS: Metered-dose inhalers with spacer produced outcomes that were at least equivalent to nebuliser delivery. Spacers may have some advantages compared to nebulisers for children with acute asthma.

PMID

16625527 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione Sistematica con Meta-analisi

Livello di evidenza

1+

Commento

Per approfondire l'argomento si vedano i numeri di giugno, agosto e ottobre 2004 della RIAP

Titolo del documento

Holding chambers (spacers) versus nebulizers for beta-agonist treatment of acute asthma

Autori e Nazionalità

Cates CJ, Crilli JA, Rowe BH. Gran Bretagna

Fonte bibliografica

Cochrane Database Syst Rev 2006 apr 19;(2):CD000052 

Lingua

Inglese

Abstract

BACKGROUND: In acute asthma inhaled beta2-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. Nebulisers require a power source and need regular maintenance, and are more expensive in the community setting. OBJECTIVES: To assess the effects of holding chambers (spacers) compared to nebulisers for the delivery of beta2-agonists for acute asthma. SEARCH STRATEGY: We last searched the Cochrane Airways Group trials register in January 2006 and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2005). SELECTION CRITERIA: Randomised trials in adults and children (from two years of age) with asthma, where spacer beta2-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. Results are reported with 95% confidence intervals (CI). MAIN RESULTS: This review has been updated in January 2006 and four new trials have been added. 2066 children and 614 adults are now included in 25 trials from emergency room and community settings. In addition, six trials on in-patients with acute asthma (213 children and 28 adults) have been reviewed. Method of delivery of beta2-agonist did not appear to affect hospital admission rates. In adults, the relative risk of admission for spacer versus nebuliser was 0.97 (95% CI 0.63 to 1.49). The relative risk for children was 0.65 (95% CI: 0.4 to 1.06). In children, length of stay in the emergency department was significantly shorter when the spacer was used, with a mean difference of -0.47 hours (95% CI: -0.58 to -0.37). Length of stay in the emergency department for adults 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 spacer in children, mean difference -7.6% baseline (95% CI: -9.9 to -5.3% baseline). AUTHORS' CONCLUSIONS: Metered-dose inhalers with spacer produced outcomes that were at least equivalent to nebuliser delivery. Spacers may have some advantages compared to nebulisers for children with acute asthma.

 

PMID

16625527 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione Sistematica con Meta-analisi

Livello di evidenza

1++

Commento

Per approfondire l'argomento si vedano i numeri della RIAP di  agosto, ottobre e maggio 2004

Titolo del documento

Holding chambers versus nebulisers for inhaled steroids in chronic asthma.

Autori e Nazionalità

Cates CJ, Adams N, Bestall J. Gran Bretagna.

Fonte bibliografica

Cochrane Database Syst Rev 2006;(1):CD001491.

Lingua

Inglese

Abstract

BACKGROUND: Inhaled corticosteroids are available in the form of a suspension for nebulisation, although the role of this mode of therapy in the treatment of chronic asthma is still unclear. OBJECTIVES: To assess the efficacy and safety of inhaled corticosteroids delivered via nebuliser versus holding chamber for the treatment of chronic asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group Trial Register (1999) and reference lists of articles. We contacted the authors of studies and pharmaceutical companies for additional studies and hand-searched the British Journal of Clinical Research, European Journal of Clinical Research and major respiratory society meeting abstracts (1997-1999). SELECTION CRITERIA: Randomised controlled trials comparing nebuliser to holding chamber in the delivery of inhaled corticosteroids for the treatment of chronic asthma. All age groups of patients were considered. Two reviewers assessed articles for inclusion; two reviewers independently assessed included studies for methodological quality. DATA COLLECTION AND ANALYSIS: One reviewer extracted data; authors were contacted to clarify missing information. Quantitative analyses were undertaken using Review Manager 4.1 with MetaView 3.1. MAIN RESULTS: Two studies were selected for inclusion (63 subjects), both concerned adults. Methodological quality was variable. Due to design differences it was not appropriate to pool the studies. The single high quality study compared budesonide 2000-8000 mcg delivered via Pari Inhalier Boy jet nebuliser with inspiration-only inhalation to budesonide 1600 mcg via large volume spacer. The nebuliser delivery led to higher morning peak expiratory flow values (25 L/min p<0.01), higher evening values (30L/min, p<0.01), lower rescue beta2 agonist use and symptom scores compared to the holding chamber delivery. REVIEWER'S CONCLUSIONS: Budesonide in high dose delivered by the particular nebuliser used in the only double-blinded study that could be included in this review was more effective than budesonide 1600 mcg via a large volume spacer. However, it is not clear whether this was an effect of nominal dose delivered or delivery system. Cost, compliance and patient preference are important determinants of clinical effectiveness that have not been assessed. Future studies are needed to evaluate the relative effectiveness of inhaled corticosteroids delivered by different combinations of nebuliser/compressor compared to holding chamber. Moreover, further studies assessing these delivery methods are needed in infants and pre-school children, as these are groups that are likely to be considered for treatment with nebulised corticosteroids.

PMID

11405994 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione Sistematica 

Livello di evidenza

1+

Commento

 

Titolo del documento

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

Autori e Nazionalità

Castro-Rodriguez JA, Rodrigo GJ. Cile

Fonte bibliografica

J Pediatr 2004;145(2):172-7

Lingua

Inglese

Abstract

OBJECTIVE: To compare the efficacy of beta-agonists given by metered-dose inhaler with a valved holding chamber (MDI+VHC) or nebulizer in children under 5 years of age with acute exacerbations of wheezing or asthma in the emergency department setting. STUDY DESIGN: Published (1966 to 2003) randomized, prospective, controlled trials were retrieved through several different databases. The primary outcome measure was hospital admission. RESULTS: Six trials (n=491) met criteria for inclusion. Patients who received beta-agonists by MDI+VHC showed a significant decrease in the admission rate compared with those by nebulizer (OR, 0.42; 95% CI, 0.24-0.72; P=.002); this decrease was even more significant among children with moderate to severe exacerbations (OR, 0.27; 95% CI, 0.13-0.54; P=.0003). Finally, measure of severity (eg, clinical score) significantly improved in the group who received beta-agonists by MDI+VHC in comparison to those who received nebulizer treatment (standardized mean difference, -0.44; 95% CI, -0.68 to -0.20; P=.0003). CONCLUSIONS: The use of an MDI+VHC was more effective in terms of decreasing hospitalization and improving clinical score than the use of a nebulizer in the delivery of beta-agonists to children under 5 years of age with moderate to severe acute exacerbations of wheezing or asthma

PMID

15289762 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione Sistematica con Meta-analisi

Livello di evidenza

1+

Commento

Per approfondire l'argomento si consigliano gli articoli pubblicati sulla RIAP  del mese di giugno 2004, agosto 2004 ed ottobre 2004