Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2000;2001(2):CD001493.
doi: 10.1002/14651858.CD001493.

Inhaled beta-agonists for asthma in mechanically ventilated patients

Affiliations

Inhaled beta-agonists for asthma in mechanically ventilated patients

A Jones et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: A small number of patients with acute severe asthma require intubation and positive pressure ventilation. The beneficial effects of inhaled bronchodilators on acute asthma in spontaneously breathing subjects are well established, but there remain important questions regarding inhaled beta2-agonists, for patients who are intubated and receiving ventilation.

Objectives: To determine the effects of inhaled beta-agonists on asthmatic patients who require intubation and mechanical ventilation.

Search strategy: Randomised controlled trials were sought from the Cochrane Airways Group Asthma Register. Primary authors and content experts were contacted to identify eligible studies and bibliographies from known reviews and texts were searched.

Selection criteria: Randomised, controlled clinical trials involving adult patients with acute asthma, who were intubated and supported with positive pressure ventilation. Studies were to be included if patients were treated with beta2-adrenergic agonist agents and there was a comparator group treated with either placebo, no medication, or 'standard' treatment.

Data collection and analysis: Two reviewers independently examined all identified articles. The full text of any potentially relevant article was reviewed independently by two reviewers.

Main results: The search yielded 152 abstracts. Of these, four articles were identified as potential trials. None of the four trials met the inclusion criteria for the review.

Reviewer's conclusions: There are no data from randomised controlled trials to provide evidence for or against current practices regarding the use of inhaled beta2-agonists in asthmatic subjects who are intubated and ventilated.

PubMed Disclaimer

Conflict of interest statement

The authors have not been involved in any trials in this area. Drs Camargo and Rowe are involved in studies with Glaxo Wellcome using inhaled corticosteroids, and Dr Rowe has conducted research in collaboration with Astra Pharma in the same topic area.

Similar articles

References

References to studies excluded from this review

Dhand 1996 {published data only}
    1. Dhand R, Duarte AG, Jubran A, Jenne JW, Fink JB, Fahey PJ, et al. Dose‐response to bronchodilator delivered by metered‐dose inhaler in ventilator‐supported patients. American Journal of Respiratory and Critical Care Medicine 1996;154(2 Pt 1):388‐93. - PubMed
Elenbaas 1985 {published data only}
    1. Elenbaas RM, Frost GL, Robinson WA, Collier RE, McNabney WK, Ryan JL, et al. Subcutaneous epinephrine vs. nebulized metaproterenol in acute asthma. Drug Intelligence and Clinical Pharmacy 1985;19:567‐71. - PubMed
Gay 1991 {published data only}
    1. Gay PC, Patel HG, Nelson SB, Gilles B, Hubmayr RD. Metered‐dose inhalers for bronchodilator delivery in intubated, mechanically ventilated patients. Chest 1991;99(1):66‐71. - PubMed
Ikeda 1990 {published data only}
    1. Ikeda K, Nakashima A, Ikeda A, Fujita H, Tsukino M. A clinical trial to determine whether intravenous aminophylline is indispensible in the treatment of status asthmaticus. Japanese Journal of Thoracic Diseases 1990;28:978‐84. - PubMed

Additional references

Ahrens 1986
    1. Ahrens RC, Ries RA, Popendorf W, Wiese JA. The delivery of therapeutic aerosols through endotracheal tubes. Pediatric Pulmonology 1986;2:19‐26. - PubMed
Bernasconi 1990
    1. Bernasconi M, Brandolese R, Poggi R, Manzin E, Rossi A. Dose response effects and time course of effects of inhaled fenoterol on respiratory mechanics and arterial oxygen tension in mechanically ventilated patients with chronic airflow obstruction. Intensive Care Medicine 1990;16:108‐14. - PubMed
Cates 2006
    1. Cates CJ. Holding chambers versus nebulisers for beta‐agonist treatment of acute asthma (Cochrane review). Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD000052.pub2] - DOI - PubMed
Crogan 1989
    1. Crogan SJ, Bishop MJ. Delivery efficiency of metered‐dose aerosols given via endotracheal tubes. Anesthesiology 1989;70(6):1008‐10. - PubMed
Dhand 1997
    1. Dhand R, Tobin MJ. Inhaled bronchodilator therapy in mechanically ventilated patients. American Journal of Respiratory & Critical Care Medicine 1997;156:3‐10. - PubMed
Fink 1996
    1. Fink JB, Dhand R, Duarte AG, Jenne JW, Tobin MJ. Aerosol delivery from a metered‐dose inhaler during mechanical ventilation: an in‐vitro model. American Journal of Respiratory & Critical Care Medicine 1996;154(2 Pt 1):382‐7. - PubMed
Fuller 1994
    1. Fuller HD, Dolovich MB, Turpie FH, Newhouse MT. Efficiency of bronchodilator aerosol delivery to the lungs from the metered‐dose inhaler in mechanically ventilated patients. A study comparing four different actuator devices. Chest 1994;105(1):214‐8. - PubMed
Lacasse 1996
    1. Lacasse Y, Boulet LP, Lampron N. The unsettled question of bronchodilator aerosol administration in mechanically ventilated patients. Canadian Respiratory Journal 1996;3:331‐4.
Nassari 1981
    1. Nassari W, Zimmerman I, Bouzrina S, Ulmer WT. The site of action of Beta‐2 sympathomimetic bronchodilators in patients with chronic obstructive airway disease. Respiration 1981;41:232‐8. - PubMed
O'Riordan 1992
    1. O'Riordan TG, Greco MJ, Perry RJ, Smaldone GC. Nebulizer function during mechanical ventilation. American Review of Respiratory Disease 1992;145:1117‐22. - PubMed
Rau 1998
    1. Rau JL, Dunlevy CL, Hill RL. A comparison of inline MDI actuators for delivery of a beta‐agonist and a corticosteroid for a mechanically ventilated lung model. Respiratory Care 1998;43:705‐12.
Taylor 1990
    1. Taylor RH, Lerman J. Experimental aerosol delivery by metered‐dose inhaler via paediatric size tracheal tubes. Canadian Journal of Anaesthesia 1990;37(4 Pt 2):S37. - PubMed
Taylor 1991
    1. Taylor RH, Lerman J. High‐efficiency delivery of salbutamol with a metered‐dose inhaler in narrow tracheal tubes and catheters. Anesthesiology 1991;74(2):360‐3. - PubMed
Travers 2004
    1. Travers A, Jones AP, Kelly K, Barker SJ, Camargo CA, Rowe BH. Intravenous beta2‐agonists for acute asthma in the emergency department. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD002988] - DOI - PMC - PubMed

Publication types

Substances