Review: β agonist delivery by metered dose inhaler with a valved holding chamber (compared with a nebuliser) reduces admissions in preschool children and infants with acute asthma or wheezing
Q What is the relative efficacy of β agonists delivered by metered dose inhaler (MDI) with a valved holding chamber (VHC) or by nebuliser in infants and preschool children with acute exacerbations of wheezing or asthma?
Medline (1966–2003), EMBASE/Excerpta Medica (1980–2003), Cochrane Controlled Trials Register; and reference lists of included studies, reviews, and texts.
Study selection and assessment:
randomised controlled trials (RCTs) in any language that compared β agonist delivery by MDI + VHC with delivery by nebuliser in infants and children <5 years of age who presented to the emergency department (ED) or equivalent setting with acute exacerbation of wheezing or asthma. Exclusion criterion: studies of admitted patients. Methodological quality of individual studies was assessed using the 5 point Jadad scale (adequacy of randomisation, blinding, and handling of withdrawals and dropouts).
primary outcome was admission to hospital; secondary outcomes included final clinical score.
6 RCTs (491 children, 1–60 mo) met the selection …