Original Articleβ-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: A systematic review with meta-analysis
Section snippets
Methods
A search was carried out by using three search strategies to identify potentially relevant trials without language restriction. First, we searched Medline (1966-2003) and Embase (1980-2003) databases by using the following MeSH, full text, and key word terms: (1) emergency or acute asthma or status asthmaticus or severe asthma or wheeze, (2) spacer or holding chamber or volumatic or nebuhaler or aerochamber or fisonair or extension or spacing device or inspirease, and (3) nebulizer. Second, an
Results
Seventy-nine articles were identified in the initial search. Of these, reviewers found that 25 papers were potentially eligible. Reasons for subsequent exclusion were studies on children >5 years old (n = 12)11., 12., 13., 14., 15., 16., 26., 27., 28., 29., 30., 31.; studies on nonacute patients (n = 4)32., 33., 34., 35.; and studies on hospitalized patients (n = 3).36., 37., 38. Finally, 6 articles were selected for inclusion in the meta-analysis.39., 40., 41., 42., 43., 44. One study was from Spain,
Discussion
The purpose of this systematic review was to compare the efficacy of β-agonists given by two different delivery methods (MDI+VHC or nebulizer) in infants or preschool children younger than 5 years of age with acute exacerbation of wheezing or asthma in the ED setting. Overall, the use of the MDI+VHC was more effective, in terms of hospitalizations and clinical score, than the use of a nebulizer. Our analysis strongly demonstrates that the administration of β-agonists by MDI+VHC significantly
Acknowledgements
We thank Dr Mark A. Brown (from the Pediatric Pulmonary Section, Arizona Respiratory Center, University of Arizona) for his advice and critical review of the manuscript.
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