Effectiveness of short-acting beta-2 agonists delivered by metered-dose inhaler with spacer versus nebulizer in acute asthma exacerbations: a systematic review and meta-analysis.
Judicael Adadja, Tarek Boumenna, Frederic Bergeron et al.
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In 30 seconds
This systematic review and meta-analysis compared short-acting beta-2 agonists delivered by metered-dose inhaler (MDI) with spacer versus nebulizer for acute asthma exacerbations. It included 20 randomized controlled trials with 2,235 participants aged 2 years or older, with separate analyses for children and adults. Overall, hospital admission did not differ significantly between delivery methods (RR = 0.90; 95% CI [0.69 to 1.18]; I² = 0%). Other overall outcomes were also similar; in children, MDI with spacer was associated with shorter emergency department stays and less tremor. Evidence certainty ranged from moderate to very low.
Key findings
- Hospital admission was similar overall with MDI and spacer versus nebulizer (RR = 0.90; 95% CI [0.69 to 1.18]; I² = 0%).
- No significant admission difference was found in adults, children, or patients with severe exacerbations.
- In children, MDI with spacer was associated with shorter emergency department stays and a lower risk of tremor.
- Overall, secondary outcomes showed no significant differences between delivery methods.
Why it matters
The findings indicate that either delivery method can achieve comparable clinical outcomes in acute asthma exacerbations, while suggesting possible advantages of MDI with spacer for children in emergency department stay and tremor. This comparison can inform consideration of delivery options, but the range of evidence certainty means the pediatric findings warrant cautious interpretation.
What to keep in mind
Certainty of evidence ranged from moderate to very low, limiting confidence in some findings.