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Meta-Analysis
. 2013 Sep 13;2013(9):CD000052.
doi: 10.1002/14651858.CD000052.pub3.

Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma

Christopher J Cates  1 , Emma J Welsh, Brian H Rowe
Affiliations
Meta-Analysis

Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma

Christopher J Cates et al. Cochrane Database Syst Rev. .

Abstract

Background: In acute asthma inhaled beta(2)-agonists are often administered by nebuliser to relieve bronchospasm, but some have argued that metered-dose inhalers with a holding chamber (spacer) can be equally effective. Nebulisers require a power source and need regular maintenance, and are more expensive in the community setting.

Objectives: To assess the effects of holding chambers (spacers) compared to nebulisers for the delivery of beta(2)-agonists for acute asthma.

Search methods: We searched the Cochrane Airways Group Trial Register and reference lists of articles. We contacted the authors of studies to identify additional trials. Date of last search: February 2013.

Selection criteria: Randomised trials in adults and children (from two years of age) with asthma, where spacer beta(2)-agonist delivery was compared with wet nebulisation.

Data collection and analysis: Two review authors independently applied study inclusion criteria (one review author for the first version of the review), extracted the data and assessed risks of bias. Missing data were obtained from the authors or estimated. Results are reported with 95% confidence intervals (CIs).

Main results: This review includes a total of 1897 children and 729 adults in 39 trials. Thirty-three trials were conducted in the emergency room and equivalent community settings, and six trials were on inpatients with acute asthma (207 children and 28 adults). The method of delivery of beta(2)-agonist did not show a significant difference in hospital admission rates. In adults, the risk ratio (RR) of admission for spacer versus nebuliser was 0.94 (95% CI 0.61 to 1.43). The risk ratio for children was 0.71 (95% CI 0.47 to 1.08, moderate quality evidence). In children, length of stay in the emergency department was significantly shorter when the spacer was used. The mean duration in the emergency department for children given nebulised treatment was 103 minutes, and for children given treatment via spacers 33 minutes less (95% CI -43 to -24 minutes, moderate quality evidence). Length of stay in the emergency department for adults was similar for the two delivery methods. Peak flow and forced expiratory volume were also similar for the two delivery methods. Pulse rate was lower for spacer in children, mean difference -5% baseline (95% CI -8% to -2%, moderate quality evidence), as was the risk of developing tremor (RR 0.64; 95% CI 0.44 to 0.95, moderate quality evidence).

Authors' conclusions: Nebuliser delivery produced outcomes that were not significantly better than metered-dose inhalers delivered by spacer in adults or children, in trials where treatments were repeated and titrated to the response of the participant. Spacers may have some advantages compared to nebulisers for children with acute asthma.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial interest in any of the devices used to deliver beta₂‐agonists in acute asthma and no involvement with the primary studies.

Figures

1
1
Study flow diagram
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Funnel plot of comparison: 1 Spacer (chamber) versus Nebuliser (Multiple treatment studies), outcome: 1.1 Hospital admission.
4
4
Forest plot of comparison: 1 Spacer (chamber) versus Nebuliser (Multiple treatment studies), outcome: 1.1 Hospital admission.
5
5
Forest plot of comparison: 1 Spacer (chamber) versus Nebuliser (Multiple treatment studies), outcome: 1.3 Duration in emergency department (minutes). [mins].
6
6
Forest plot of comparison: 1 Spacer (chamber) versus Nebuliser (Multiple treatment studies), outcome: 1.9 Rise in pulse rate (% baseline) [%].
1.1
1.1. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 1 Hospital admission.
1.2
1.2. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 2 Hospital admission or poor response to treatment.
1.3
1.3. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 3 Duration in emergency department (minutes)..
1.4
1.4. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 4 Final rise in FEV₁ (% predicted).
1.5
1.5. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 5 30 minute rise in FEV₁ (% predicted).
1.6
1.6. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 6 Severe asthmatics final rise in FEV₁ (% predicted).
1.7
1.7. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 7 Final rise in peak flow (% predicted).
1.8
1.8. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 8 30 minute rise in peak flow (% predicted).
1.9
1.9. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 9 Rise in pulse rate (% baseline).
1.10
1.10. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 10 % Oxygen saturation (change from baseline).
1.11
1.11. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 11 Number of participants developing tremor.
1.12
1.12. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 12 Number of participants given steroids.
1.13
1.13. Analysis
Comparison 1 Spacer (chamber) versus nebuliser (multiple‐treatment studies), Outcome 13 Rise in respiratory rate (breaths per minute).
2.1
2.1. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 1 Hospital admission.
2.2
2.2. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 2 Final peak flow (% predicted).
2.3
2.3. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 3 30 minute rise in FEV₁ (% predicted).
2.4
2.4. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 4 15 minute rise in FEV₁ (% predicted).
2.5
2.5. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 5 30 minute rise in peak flow (% predicted).
2.6
2.6. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 6 15 minute rise in peak flow (% predicted).
2.7
2.7. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 7 Rise in pulse rate (% baseline).
2.8
2.8. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 8 Number of participants developing tremor.
2.9
2.9. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 9 Number of participants with deterioration in blood gases.
2.10
2.10. Analysis
Comparison 2 Spacer (chamber) versus nebuliser (single‐treatment studies), Outcome 10 Rise in respiratory rate.
3.1
3.1. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 1 Duration of hospital admission (days).
3.2
3.2. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 2 Number of hours until reached 4‐hourly dosing regimen.
3.3
3.3. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 3 Total number of inhaled doses received.
3.4
3.4. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 4 Number of participants returning to normal PEFR and respiratory score levels (end of study).
3.5
3.5. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 5 Number of symptom‐free participants 14 days post‐discharge.
3.6
3.6. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 6 Readmissions in the subsequent 12 months.
3.7
3.7. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 7 Clinical asthma score (end of trial).
3.8
3.8. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 8 Maximum percentage decrease in respiratory score.
3.9
3.9. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 9 Respiratory rate at discharge.
3.10
3.10. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 10 Heart rate at discharge.
3.11
3.11. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 11 Oxygen saturations at discharge.
3.12
3.12. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 12 30 minute rise in FEV₁.
3.13
3.13. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 13 Final rise in FEV₁.
3.14
3.14. Analysis
Comparison 3 Spacer (chamber) versus nebuliser (inpatient studies), Outcome 14 Final rise in peak flow (% change from baseline).
4.1
4.1. Analysis
Comparison 4 Spacer (chamber) versus nebuliser (multiple‐treatment studies with Volumatic subgroups), Outcome 1 Hospital admission.
4.2
4.2. Analysis
Comparison 4 Spacer (chamber) versus nebuliser (multiple‐treatment studies with Volumatic subgroups), Outcome 2 Hospital admission or poor response to treatment.
4.3
4.3. Analysis
Comparison 4 Spacer (chamber) versus nebuliser (multiple‐treatment studies with Volumatic subgroups), Outcome 3 Duration in emergency department (minutes)..
4.4
4.4. Analysis
Comparison 4 Spacer (chamber) versus nebuliser (multiple‐treatment studies with Volumatic subgroups), Outcome 4 Final rise in FEV₁ (% predicted).
4.5
4.5. Analysis
Comparison 4 Spacer (chamber) versus nebuliser (multiple‐treatment studies with Volumatic subgroups), Outcome 5 30 minute rise in FEV₁ (% predicted).
4.6
4.6. Analysis
Comparison 4 Spacer (chamber) versus nebuliser (multiple‐treatment studies with Volumatic subgroups), Outcome 6 Severe asthmatics final rise in FEV₁ (% predicted).
4.7
4.7. Analysis
Comparison 4 Spacer (chamber) versus nebuliser (multiple‐treatment studies with Volumatic subgroups), Outcome 7 Final rise in peak flow (% predicted).
4.8
4.8. Analysis
Comparison 4 Spacer (chamber) versus nebuliser (multiple‐treatment studies with Volumatic subgroups), Outcome 8 30 minute rise in peak flow (% predicted).
4.9
4.9. Analysis
Comparison 4 Spacer (chamber) versus nebuliser (multiple‐treatment studies with Volumatic subgroups), Outcome 9 Rise in pulse rate (% baseline).
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

Ba 1989 {published data only}
    1. Ba M, Spier S, Lapierre G, Lamarre A. Wet nebulizer versus spacer and metered dose inhaler via tidal breathing. Journal of Asthma 1989;26:355‐8. [MEDLINE: ] - PubMed
Batra 1997 {published data only}
    1. Batra V, Sethi G, Sachdev H. Comparative efficacy of jet nebuliser and metered dose inhaler with spacer device in the treatment of acute asthma. Indian Pediatrics 1997;34:497‐503. - PubMed
Burrows 2004 {published and unpublished data}
    1. Burrows T, Connett GJ. The relative benefits and acceptability of metered dose inhalers and nebulisers to treat acute asthma in preschool children [Abstract]. Thorax 2004;59(Suppl II):ii20. [CN‐00517341]
Chong‐Neto 2005 {published data only}
    1. Alves Cardozo C. Cost of treatment of acute asthma in children using different inhaler devices [Dissertation]. Pontifícia Universidade Católica do Paraná (Brazil) 2005:88p.
    1. Chong‐Neto HJ, Chong‐Silva DC, Marani DM, Kuroda F, Olandowisky M, Noronha L, et al. Different inhaled devices in acute asthma attacks: a randomized, double‐blinded, placebo controlled study. Jornal de Pediatria 2005;81:298‐304. - PubMed
Chou 1995 {published and unpublished data}
    1. Chou KJ, Cunningham SJ, Crain EF. Metered‐dose inhalers with spacers versus nebulizers for pediatric asthma. Archives of Pediatrics and Adolescent Medicine 1995;149:201‐5. - PubMed
Coker 1995 {published data only}
    1. Coker M, Tanac R. Comparison of three methods of inhaling salbutamol in acute childhood asthma. Turkish Journal of Medical Sciences 1995;23:293‐7.
Colacone 1993 {published data only}
    1. Colacone A, Afilalo M, Wolkove N, Kreisman H. A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma. Chest 1993;104:835‐41. - PubMed
Dewar 1999 {published data only}
    1. Dewar AL, Stewar A, Cogswell JJ, Connett GL. A randomised controlled trial to assess the relative benefits of large volume spacers and nebulisers to treat acute asthma in hospital. Archives of Disease in Childhood 1999;80:421‐3. - PMC - PubMed
Dhuper 2008 {published data only}
    1. Dhuper S, Chandra A, Ahmed A, Bista S, Moghekar A, Verma R, et al. Bronchodilator administration between MDI's with a disposable spacer and nebulizer used for acute asthma treatment: a comparison of efficacy and cost analysis [Abstract]. American Thoracic Society International Conference; 2008 May 16‐21; Toronto. 2008.
    1. Dhuper S, Chandra A, Ahmed A, Bista S, Moghekar A, Verma R, et al. Efficacy and cost comparisons of bronchodilatator administration between metered dose inhalers with disposable spacers and nebulizers for acute asthma in an inner‐city adult population. Journal of Emergency Medicine 2011; Vol. 40, issue 3:247‐255. - PubMed
Direkwatanachai 2008 {published data only}
    1. Direkwatanachai C, Teeratakulpisarn J, Suntornlohanakul S, Trakultivakorn M, Ngamphaiboon J, Wongpitoon N, et al. Comparison of salbutamol efficacy in children‐‐via the metered‐dose inhaler (MDI) with Volumatic spacer and via the dry powder inhaler, Easyhaler, with the nebulizer‐‐in mild to moderate asthma exacerbation: a multicenter, randomized study. Asia‐Pacific Journal of Allergy and Immunology 2011;29:25‐33. - PubMed
    1. Sirikul C, Chumpakdee K, Vangveeravong M. A comparative study of efficacy of salbutamol via metered dose inhaler (MDI) with volumatic spacer and via dry powder inhaler (DPI) Easyhaler to nebulization in mild to moderate severity acute asthma exacerbation in children [Abstract]. Journal of Allergy and Clinical Immunology 2008;121(2 Suppl 1):S156.
    1. Vangveeravong M. A comparative study of efficacy of salbutamol via metered dose inhaler with volumatic spacer and via dry powder inhaler, easyhaler, to nebulization in mild to moderate severity acute asthma exacerbation in childhood. Journal of the Medical Association of Thailand 2008;91(Suppl 3):S115‐23. - PubMed
Duarte 2002 {published data only}
    1. Duarte M, Camargos P. Efficacy and safety of a home‐made non‐valved spacer for bronchodilator therapy in acute asthma. Acta Paediatrica 2002;91:909‐13. - PubMed
Ferrés 1989 {published data only}
    1. Ferrés J, Querol J, Guasch, E. Beta2‐adrenergic stimulants: Nebulizer versus holding chambers for the treatment of pediatric acute asthma. Anales Españoles de Pediatría 1989;31(2):175.
Freelander 1984 {published data only}
    1. Freelander M, Asperen PP. Nebuhaler versus nebuliser in children with acute asthma. BMJ 1984;288:1873‐4. - PMC - PubMed
Hussein 2002 {published data only}
    1. Hussein ZM, Bader‐Eldin OMK, Galal AA, Abd‐Allah SA. Metered dose inhaler with spacer versus nebulizer in children with acute bronchial asthma. European Respiratory Society Annual Congress; 2002 Sep 14‐18; Sweden. 2002.
Idris 1993 {published data only}
    1. Idris AH, McDermott MF, Raucci JC, Morrabel A, McGorray S, Hendeles L. Emergency department treatment of severe asthma. Metered‐dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Chest 1993;103:665‐72. - PubMed
Jamalvi 2006 {published data only}
    1. Jamalvi SW, Raza SJ, Naz F, Shamim S, Jamalvi SM. Management of acute asthma in children using metered dose inhaler and small volume nebulizer. Journal of the Pakistan Medical Association 2006; Vol. 56, issue 12:595‐9. - PubMed
Kerem 1993 {published and unpublished data}
    1. Kerem E, Levison H, Schuh S, OBrodovich H, Reisman J, Bentur L, et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. Journal of Pediatrics 1993;123:313‐7. - PubMed
Leversha 2000 {published data only}
    1. Leversha AM, Campanella SG, Aickin RP, Asher MI. Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe asthma. Journal of Pediatrics 2000;136(4):497‐502. - PubMed
Lin 1995 {published and unpublished data}
    1. Lin Y‐Z, Hsieh K‐H. Metered dose inhaler and nebuliser in acute asthma. Archives of Disease in Childhood 1995;72:214‐8. - PMC - PubMed
Maldano‐Alanis 1997 {published data only}
    1. Maldano‐Alanis M, Linares‐Zapien F, Rio‐Navarro B, Sienna‐Monge J. Comparison between salbutamol administered through metered dose inhalers with spacers vs nebulisers in children with acute asthma. Boletin Medico del Hospital Infantil de Mexico 1997;54:374‐8.
Morley 1988 {published data only}
    1. Morley TF, Marozsan E, Zappasodi SJ, Gordon R, Griesback R, Giudice JC. Comparison of beta‐adrenergic agents delivered by nebulizer vs metered dose inhaler with InspirEase in hospitalised asthmatic patients. Chest 1988;94(6):1205‐10. - PubMed
Morrone 1990 {published and unpublished data}
    1. Morrone N, Freire JA, Pereira CA, Ferreira AK. Bronchodilation induced by fenoterol in asthmatic patients: comparison of jet nebulization and spacer device. Revista Paulista de Medicina 1990;108:83‐7. - PubMed
Parkin 1995 {published data only}
    1. Parkin PC, Saunders NR, Diamond SA, Winders PM, Macarthur C. Randomised trial spacer v nebuliser for acute asthma. Archives of Disease in Childhood 1995;72:239‐40. - PMC - PubMed
Pendergast 1989 {published data only}
    1. Pendergast J, Hopkins J, Timms B, Asperen PP. Comparative efficacy of terbutaline administered by Nebuhaler and by nebulizer in young children with acute asthma. Medical Journal of Australia 1989;151:406‐8. - PubMed
Ploin 2000 {published and unpublished data}
    1. Ploin D, Chapuis FR, Stamm D, Robert J, David L, Chatelain PG, et al. High dose aerosolised salbutamol via chamber and nebuliser in wheezy infants and young children [Fortes doses de salbutamol par aérosol doseur et chambre d'inhalation chez les nourrissons et les jeunes enfants siffleurs]. Revue Francaise D' Allergologie Immunologie Clinique 2001;41:155‐64.
    1. Ploin D, Chapuis FR, Stamm D, Robert J, David L, Chatelain PG, et al. High‐dose Albuterol by metered‐dose inhaler plus a spacer device versus nebulisation in pre‐school children with recurrent wheezing: a double‐blind, randomised equivalence trial. Pediatrics 2000;106(2):311‐7. - PubMed
Raimondi 1997 {published data only}
    1. Raimondi AC, Schottlender J, Lombardi D, Molfino N. Treatment of acute severe asthma with inhaled albuterol delivered by jet nebulizer, metered dose inhaler with spacer or dry powder. Chest 1997;112(1):24‐8. - PubMed
Rao 2002 {published data only}
    1. Rao NA, Rizvi N. The efficacy of salbutamol delivered by inhaler plus spacer device and nebulizer in acute asthma: a comparative study. Journal‐College of Physicians and Surgeons of Pakistan 2002;12(10):579‐82.
Robertson 1998 {published data only}
    1. Robertson C, Norden M, Fitzgerald D, Connor F, Asperen PP, Cooper PJ, et al. Treatment of acute asthma: salbutamol via jet nebuliser vs spacer and metered dose inhaler. Journal of Paediatrics and Child Health 1998;34:142‐6. - PubMed
Rodrigo 1993 {published data only}
    1. Rodrigo G, Rodrigo C. Comparison of salbutamol delivered by nebulizer or metered‐dose inhaler with a pear‐shaped spacer in acute asthma. Current Therapeutic Research, Clinical and Experimental 1993;54:797‐808.
Rodrigo 1998 {published data only}
    1. Rodrigo C, Rodrigo G. Salbutamol treatment of acute severe asthma in the ED: MDI versus hand held nebulizer. American Journal of Emergency Medicine 1998;16:637‐42. - PubMed
Rodriguez 1999 {unpublished data only}
    1. Rodriguez IS, Buitrago JR, Garcia RL. Nebulizer versus inhaler plus holding chamber for acute asthma in adults. Data on file 1999.
Salzman 1989 {published data only}
    1. Salzman GA, Steele MT, Pribble JP, Elenbaas RM, Pyszczynski DR. Aerosolized metaproterenol in the treatment of asthmatics with severe airflow obstruction. Comparison of two delivery methods. Chest 1989;95:1017‐20. - PubMed
Sannier 2007 {published data only}
    1. Sannier N, Timsit S, Cojocaru B, Leis A, Wille C, Garel D, et al. Metered‐dose inhaler with spacer versus nebulization for severe and potentially severe acute asthma treatment in the pediatric emergency department. [French]. Revue Francaise d Allergologie et d Immunologie Clinique 2007; Vol. 47, issue 2:64‐71. - PubMed
Turner 1988 {published and unpublished data}
    1. Turner JR, Corkery KJ, Eckman D, Gelb AM, Lipavsky A, Sheppard D. Equivalence of continuous flow nebulizer and metered‐dose inhaler with reservoir bag for treatment of acute airflow obstruction. Chest 1988;93:476‐81. - PubMed
Valencia 1999 {published data only}
    1. Valencia ML, Manotas R. Inhaled versus nebulised salbutamol in the management of acute asthma exacerbation in pre‐school children. A randomised comparative trial [Salbutamol inhalado o nebulizado en el tratamiento de la exacerbacion aguda del asma en el preescolar. Estudio comparativo aleatorizado]. Iatreia 1999;12(3):130‐4.
Vazquez 1992 {published data only}
    1. Vazquez Cordero C, Corera Sanchez M, Molinuevo Alvaro J. Comparison of treatment of acute asthma attacks in children with salbutamol dispensed by the Volumatic dispenser or by a nebulizer. Anales Espanoles de Pediatria 1992;36:359‐62. - PubMed
Vivek 2003 {published and unpublished data}
    1. Vivek P, Joshi M. A randomised controlled trial comparing the efficacy of inhalation therapy by spacer device v nebulizer in acute exacerbation of asthma. Thorax 2003;58(Suppl 3):iii44.
Williams 1996 {published data only}
    1. Williams JR, Bothner JP, Swanton RD. Delivery of albuterol in a pediatric emergency department. Pediatric Emergency Care 1996;12(4):263‐7. - PubMed
Yasmin 2012 {published data only}
    1. Yasmin S, Mollah AH, Basak R, Islam KT, Chowdhury YS. Efficacy of salbutamol by nebulizer versus metered dose. Mymensingh Medical Journal 2012; Vol. 21, issue 1:66‐71. - PubMed

References to studies excluded from this review

Beasley 1985 {published data only}
    1. Beasley CRW, O'Donnell TV. Pear shaped spacer Nebuhaler compared with nebulised solution for terbutaline administration in acute severe asthma. New Zealand Medical Journal 1985;98:854‐5. [MEDLINE: ] - PubMed
Benton 1989 {published data only}
    1. Benton G, Thomas RC, Nickerson BG, McQuitty JC, Okikawa J. Experience with a metered dose inhaler with spacer in pediatric emergency department. Annals of Disease in Childhood 1989;43:678‐81. - PubMed
Berenberg 1985 {published data only}
    1. Berenberg MJ, Baigelmann W, Cupples LA, Pearce L. Comparison of metered‐dose inhaler attached to an aerochamber with an updraft nebuliser for the administration of metaproterenol in hospitalised patients. Journal of Asthma 1985;22:87‐92. - PubMed
Campbell 1995 {published data only}
    1. Campbell IA, Colman SB, Mao JH, Prescott RJ, Weston CFM. An open, prospective comparison of beta 2 agonists given via nebuliser, Nebuhaler, or pressurised inhaler by ambulance crew as emergency treatment. Thorax 1995;50:79‐80. [MEDLINE: ] - PMC - PubMed
Deerojanawong 2005 {published data only}
    1. Deerojanawong J, Manuyakorn W, Prapphal N, Harnruthakorn C, Sritippayawan S, Samransamruajkit R. Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler‐spacer vs. jet nebulizer in young children with wheezing. Pediatric Pulmonology 2005;39(5):466‐72. - PubMed
    1. Wiparat, M. A prospective randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler‐spacer versus jet nebulizer for young children with acute wheezing [Dissertation]. Chulalongkorn Univerisity. Bangkok. (Thailand). Graduate School. 2002.
Fayaz 2009 {published data only}
    1. Fayaz M, Sultan A, Rai M E. Comparison between efficacy of mdi+spacer and nebuliser in the management of acute asthma in children. Journal of Ayub Medical College Abbottabad 2009;21(1):32‐4. - PubMed
Fuglsang 1986 {published data only}
    1. Fuglsang G, Pedersen S. Comparison of Nebuhaler(R) and nebulizer treatment of acute severe asthma in children. European Respiratory Journal 1986;69:109‐13. [MEDLINE: ] - PubMed
Hart 2009 {published data only}
    1. Hart M, Abmas E, Boehm R, Hernandez G, Millard M. Comparison of valved‐holding chamber (VHC)‐facemask/mouthpiece with small volume nebulizer‐facemask (SVN‐F for bronchodilator delivery [Abstract]. European Respiratory Society Annual Congress; 2009 Sep 12‐16; Vienna. 2009.
Hodder 1988 {published data only}
    1. Hodder RV, Calcutt LE, Leech JA. Metered dose inhaler with spacer is superior to wet nebulisation for emergency room treatment of acute severe asthma. Chest 1988;94 Suppl:53.
Jasper 1987 {published data only}
    1. Jasper AC, Mohsenifar Z, Kafan S, Goldberg H, Koerner SK. Cost‐benefit comparison of aerosol bronchodilator delivery methods in hospitalised patients. Chest 1987;91:614‐8. - PubMed
Kaashmiri 2010 {published data only}
    1. Kaashmiri M, Shepard J, Goodman B, Lincourt WR, Trivedi R, Ellsworth A, et al. Repeat dosing of albuterol via metered‐dose inhaler in infants with acute obstructive airway disease: A randomized controlled safety trial. Paediatric Emergency Care 2010;26(3):197‐202. - PubMed
Levitt 1995 {published data only}
    1. Levitt MA, Gambrioli EF, Fink JB. Comparative trial of continuous nebulization versus metered‐dose inhaler in the treatment of acute bronchospasm. Annals of Emergency Medicine 1995;26:273‐7. - PubMed
Madsen 1982 {published data only}
    1. Madsen EB, Bundgaard A, Hidinger K. Cummulative dose‐response study comparing terbutaline pressurised aerosol administered via a pear‐shaped spacer and terbutaline in a nebulized solution. European Journal of Clinical Pharmacology 1982;23:27‐30. - PubMed
Maguire 1991 {published data only}
    1. Maguire GP, Newman T, DeLorenzo LJ, Brown RB, Stone D. Comparison of a hand‐held nebulizer with a metered dose inhaler‐spacer combination in acute obstructive pulmonary disease. Chest 1991;100:1300‐5. [MEDLINE: ] - PubMed
Mandelberg 1997 {published data only}
    1. Mandelberg A, Chen E, Noviski N, Priel I. Nebulized wet aerosol treatment in emergency department ‐ is it essential. Chest 1997;112:1501‐5. - PubMed
Mandelberg 2000 {published data only}
    1. Mandelberg A, Tsehori S, Houri S, Gilad E, Morag B, Priel IE. Is nebulized aerosol treatment necessary in a pediatric emergency department? Comparison with a metal spacer device for metered‐dose inhaler. Chest 2000;117(5):1309‐13. - PubMed
Morgan 1982 {published data only}
    1. Morgan MDL, Singh BV, Frame MH, Williams SJ. Terbutaline aerosol given through pear spacer in acute severe asthma. BMJ 1982;285:849‐50. - PMC - PubMed
Newman 2002 {published data only}
    1. Newman KB, Milne S, Hamilton C, Hall K. A comparison of albuterol administered by metered‐dose inhaler and spacer with albuterol by nebulizer in adults presenting to an urban emergency department with acute asthma. Chest 2002;121:1036‐41. - PubMed
Rubilar 2000 {published data only}
    1. Rubilar L, Castro‐Rodriguez JA, Girardi G. Randomized trial of salbutamol via metered‐dose inhaler with spacer versus nebulizer for acute wheezing in children less than 2 years of age. Pediatric Pulmonology 2000;29:264‐9. - PubMed
Shaikh 2001 {published data only}
    1. Shaikh GP, Pednekar S, Paidhungat AJ, Nabar ST, Iyenger V, Khatri DP. A study of pulmonary functions, metabolic parameters and electro‐cardiogram after salbutamol for bronchial asthma using two delivery systems. Indian Practitioner 2001;54(9):619‐23.
Shim 1984 {published data only}
    1. Shim CS, Williams MH. Effect of bronchodilator therapy administered by canister versus jet nebulizer. Journal of Allergy and Clinical Immunology 1984;73:387‐90. - PubMed
Summer 1989 {published data only}
    1. Summer W, Elston R, Tharpe L, Nelson S, Haponik EF. Aerosol bronchodilator delivery methods. Relative impact on pulmonary function and cost of respiratory care. Archives of Internal Medicine 1989;149:618‐23. [MEDLINE: ] - PubMed
Tarala 1980 {published data only}
    1. Tarala RA, Madsen BW, Paterson JW. Comparative efficacy of salbutamol by pressurized aerosol and wet nebulizer in acute asthma. British Journal of Clinical Pharmacology 1980;10:393‐7. - PMC - PubMed
Vilarinho 2003 {published data only}
    1. Vilarinho LC, Cardeal Mendes CM, Freitas Souza LS. Metered‐dose inhalers with home‐made spacers versus nebulizers to treat moderate wheezing attacks in children. Jornal de Pediatria 2003;79(5):403‐12. [PUBMED: 14557840] - PubMed
Wildhaber 1999 {published data only}
    1. Wildhaber JH, Dore ND, Wilson JM, Devadson SG, LeSouef PN. Inhalation therapy in asthma: nebulizer or pressurised metered‐dose inhaler with holding chamber? In vivo comparison of lung deposition in children. Journal of Pediatrics 1999;135(1):28‐33. - PubMed

Additional references

BTS/SIGN 2011
    1. British Guideline on the Management of Asthma. A national clinical guideline. May 2008. Revised May 2011. British Thoracic Society www.brit‐thoracic.org.uk and Scottish Intercollegiate Guidelines Network www.sign.ac.uk.
GINA 2012
    1. Global Initiative for Asthma (GINA). The Global Strategy for Asthma Management and Prevention. www.ginasthma.org/ (accessed 1st June 2013) 2012.
Gleeson 1988
    1. Gleeson JGA, Price JF. Nebuhaler technique. British Journal of Diseases of the Chest 1988;82:172‐4. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Lipworth 1997
    1. Lipworth BJ, Clark DJ. Effects of airway calibre on lung delivery of nebulised salbutamol. Thorax 1997;52(12):1036‐9. - PMC - PubMed
Newman 1984
    1. Newman SP, Millar AB, Lennard‐Jones TR, Moran F, Clarke SW. Improvement of pressurised aerosol deposition with Nebuhaler spacer device. Thorax 1984;39:935‐41. - PMC - PubMed
Osmond 2007
    1. Osmond MH, Gazarian M, Henry RL, Clifford TJ, Tetzlaff J. Barriers to metered‐dose inhaler/spacer use in Canadian pediatric emergency departments: a national survey. Academic Emergency Medicine 2007;14(11):1106‐13. - PubMed
Powell 2001
    1. Powell CV, Maskell GR, Marks MK, South M, Robertson CF. Successful implementation of spacer treatment guideline for acute asthma. Archives of Disease in Childhood 2001;84:142‐6. - PMC - PubMed
Rodrigo 1996
    1. Rodrigo G, Rodrigo C. Metered dose inhaler Salbutamol treatment of asthma in the ED: a comparison of two doses with plasma levels. American Journal of Emergency Medicine 1996;14:144‐50. - PubMed
Rowe 2007
    1. Rowe BH, Spooner CH, Ducharme FM, Bretzlaff JA, Bota GW. Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD000195.pub2] - DOI - PubMed
Schuh 1989
    1. Schuh S, Parkin P, Rajan A, Canny G, Healy R, Reider M, et al. High‐ versus low‐dose, frequently administered, nebulised albuterol in children with acute severe asthma. Pediatrics 1989;83:513‐8. - PubMed
Turner 1997
    1. Turner MO, Patel A, Ginsburg S, Fitzgerald JM. Bronchodilator delivery in acute airflow obstruction. Archives of Internal Medicine 1997;157:1736‐44. - PubMed

References to other published versions of this review

Cates 2004
    1. Cates CJ, Bara A, Crilly JA, Rowe BH. Holding chambers versus nebulisers for beta‐agonist treatment of acute asthma. Cochrane Database of Systematic Reviews 2004, Issue 3. [DOI: 10.1002/14651858.CD000052] - DOI - PubMed
Cates 2006
    1. Cates CJ, Crilly JA, Rowe BH. Holding chambers (spacers) versus nebulisers for beta‐agonist treatment of acute asthma. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD000052.pub2] - DOI - PubMed

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