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. 2001;2001(2):CD002988.
doi: 10.1002/14651858.CD002988.

Intravenous beta2-agonists for acute asthma in the emergency department

A Travers  1 , A P Jones, K Kelly, S J Barker, C A Camargo, B H Rowe
Affiliations

Intravenous beta2-agonists for acute asthma in the emergency department

A Travers et al. Cochrane Database Syst Rev. 2001.

Abstract

Background: Inhaled beta-agonist therapy is central to the management of acute asthma. The use of intravenous beta-agonist agents may also be beneficial in this setting.

Objectives: To determine the benefit of intravenous (IV) beta2-agonists for severe acute asthma treated in the emergency department.

Search strategy: Randomised controlled trials (RCT) were identified using the Cochrane Airways Group Register which is a compilation of systematic searches of MEDLINE, EMBASE, CINAHL, and CENTRAL as well as hand searching of 20 respiratory journals. Bibliographies from included studies and known reviews were also searched. Primary authors and content experts were contacted to identify eligible studies.

Selection criteria: Only RCTs were considered for inclusion. Studies were included if patients presented to the emergency department with acute asthma and were treated with IV selective or nonselective beta2-agonists versus placebo, inhaled beta2-agonists, or other standard of care. Pulmonary function, vital signs, arterial gasses, adverse effects, and/or clinical success could be reported as outcome measures. Two reviewers independently selected potentially relevant articles and selected articles for inclusion. Methodological quality was independently assessed using two scoring systems and two reviewers.

Data collection and analysis: Data were extracted independently by two reviewers, and confirmed with corresponding authors. Missing data were obtained from authors or calculated from data present in the papers. Trials were combined using a random effects model for odds ratios (OR) or weighted mean differences (WMD) and reported with 95% confidence intervals (95% CI).

Main results: From 746 identified references, 55 potentially relevant articles were identified and 15 were included. The trials included 584 patients. Overall, selective IV beta2-agonist use conferred no advantage over the comparator regimes. For example, it was associated with a lower PEFR after 60 mins compared to inhaled beta2-agonist, although the difference was not statistically significant (-24.7 l/min; 95%CI 2.9, -52.3). There was no difference in heart rate (4.5 bpm; 95% CI -4.9, 14.0). In the well performed blinded studies there was no difference in autonomic side effects between treatments (Odds Ratio 2.2 (95%CI 0.9, 5.7).

Reviewer's conclusions: There is no evidence to support the use of IV beta2-agonists in patients with severe acute asthma. These drugs should be given by inhalation. No subgroups were identified in which the IV route should be considered.

PubMed Disclaimer

Conflict of interest statement

None. The authors are not involved in the primary research reported in this systematic review and have not represented the producers of these agents in the past.

Figures

1.1
1.1. Analysis
Comparison 1 IV vs. All Treatments, Outcome 1 PEFR ( l/min) @ 15 minutes.
1.2
1.2. Analysis
Comparison 1 IV vs. All Treatments, Outcome 2 PEFR ( l/min) @ 30 minutes.
1.3
1.3. Analysis
Comparison 1 IV vs. All Treatments, Outcome 3 PEFR ( l/min) @ 45 minutes.
1.4
1.4. Analysis
Comparison 1 IV vs. All Treatments, Outcome 4 PEFR ( l/min) @ 60 minutes.
1.5
1.5. Analysis
Comparison 1 IV vs. All Treatments, Outcome 5 PEFR ( l/min) @ 120 min.
1.6
1.6. Analysis
Comparison 1 IV vs. All Treatments, Outcome 6 PEFR ( l/min) Final.
1.7
1.7. Analysis
Comparison 1 IV vs. All Treatments, Outcome 7 Arterial Oxygen Tension (mm Hg).
1.8
1.8. Analysis
Comparison 1 IV vs. All Treatments, Outcome 8 Arterial Carbon Dioxide Tension (mm Hg).
1.9
1.9. Analysis
Comparison 1 IV vs. All Treatments, Outcome 9 Heart Rate @ 15 min.
1.10
1.10. Analysis
Comparison 1 IV vs. All Treatments, Outcome 10 Heart Rate @ 30 minutes.
1.11
1.11. Analysis
Comparison 1 IV vs. All Treatments, Outcome 11 Heart Rate @ 45 minutes.
1.12
1.12. Analysis
Comparison 1 IV vs. All Treatments, Outcome 12 Heart Rate @ 60 minutes.
1.13
1.13. Analysis
Comparison 1 IV vs. All Treatments, Outcome 13 Heart Rate @ 120 minutes.
1.14
1.14. Analysis
Comparison 1 IV vs. All Treatments, Outcome 14 Heart Rate Final.
1.15
1.15. Analysis
Comparison 1 IV vs. All Treatments, Outcome 15 Diastolic Blood Pressure @ 60 minutes.
1.16
1.16. Analysis
Comparison 1 IV vs. All Treatments, Outcome 16 Autonomic Side Effects.
1.17
1.17. Analysis
Comparison 1 IV vs. All Treatments, Outcome 17 Clinical Failure.
2.1
2.1. Analysis
Comparison 2 % Predicted PEFR Trials, Outcome 1 % pred PEFR at 1 hour.
2.2
2.2. Analysis
Comparison 2 % Predicted PEFR Trials, Outcome 2 % pred PEFR at 2 hours.
2.3
2.3. Analysis
Comparison 2 % Predicted PEFR Trials, Outcome 3 % pred PEFR at 3 hours.
2.4
2.4. Analysis
Comparison 2 % Predicted PEFR Trials, Outcome 4 % pred PEFR at 6 hours.
3.1
3.1. Analysis
Comparison 3 FEV1 Trials, Outcome 1 FEV1 (L) at 15 minutes.
3.2
3.2. Analysis
Comparison 3 FEV1 Trials, Outcome 2 FEV1 (L) at 1 hour.
3.3
3.3. Analysis
Comparison 3 FEV1 Trials, Outcome 3 FEV1 (L) at 3 hours.
4.1
4.1. Analysis
Comparison 4 Comparison by Quality, Outcome 1 PEFR ( l/min) at 60 minutes.
4.2
4.2. Analysis
Comparison 4 Comparison by Quality, Outcome 2 PEFR ( l/min) at 120 minutes.
4.3
4.3. Analysis
Comparison 4 Comparison by Quality, Outcome 3 PEFR ( l/min) Final.
4.4
4.4. Analysis
Comparison 4 Comparison by Quality, Outcome 4 Heart Rate at 60 minutes.
4.5
4.5. Analysis
Comparison 4 Comparison by Quality, Outcome 5 Heart Rate at 120 minutes.
4.6
4.6. Analysis
Comparison 4 Comparison by Quality, Outcome 6 Autonomic Side Effects.
4.7
4.7. Analysis
Comparison 4 Comparison by Quality, Outcome 7 Clinical Failure.
See this image and copyright information in PMC

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