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Report by Stuart Teece,Research Fellow Search checked by Kevin Mackway-Jones, Professor
Clinical scenario
A 24 year old known asthmatic is brought into the emergency department by friends. She has been in a smoky bar and has become very wheezy. You assess her asthma as severe. You wonder whether a nebuliser is necessary, or whether a spacer device will suffice.
Three part question
In [an adult with acute severe asthma] is [delivery of bronchodilator therapy via nebuliser or spacer] better at [impoving airflow and reducing the need for admission]?
Search strategy
Medline 1966–12/01 using the OVID interface. ([exp asthma OR asthma.mp] AND [exp bronchodilator agents OR bronchodilator$.mp] AND [exp nebulizers and vaporizers OR nebulise$.mp OR nebulize$.mp OR spacer$.mp]) LIMIT to human AND english language.
Search outcome
Altogether 1734 papers found of which two were meta-analyses that included all other relevant papers (table 6).
Comment
The two meta-analyses have four studies (199 patients) in common.
CLINICAL BOTTOM LINE
Spacer devices can be used in place of nebulisers in patients with acute severe asthma.
Report by Stuart Teece,Research Fellow Search checked by Kevin Mackway-Jones, Professor