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Bronchodilator delivery in acute airflow obstruction. A meta-analysis
M O Turner1, A Patel, S Ginsburg
1Department of Medicine, University of British Columbia, Vancouver. markf@unixg.ubc.ca
Archives of Internal Medicine
|August 11, 1997
Summary
Metered-dose inhalers (MDIs) and wet nebulizers are equally effective for acute airflow obstruction treatment in adults. MDIs with spacer devices are recommended for optimal bronchodilator delivery during acute exacerbations.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Acute airflow obstruction requires prompt bronchodilator therapy.
- Delivery methods include metered-dose inhalers (MDIs) and wet nebulizers.
- Optimal delivery method for acute exacerbations remains a clinical question.
Purpose of the Study:
- To compare the efficacy of bronchodilator delivery via MDI versus wet nebulizer.
- To assess objective measures of acute airflow obstruction in adult patients.
- To evaluate treatment outcomes in asthma and COPD exacerbations.
Main Methods:
- Systematic review and meta-analysis of 18 randomized controlled trials (1966-1994).
- Included adults with acute asthma or COPD exacerbations treated in emergency or hospital settings.
- Extracted data on patient characteristics, doses, outcomes, and study quality.
Main Results:
- No statistically significant difference in airflow obstruction improvement between MDI and wet nebulizer delivery (effect size -0.02).
- Most MDI studies utilized spacer devices, which are recommended.
- Subgroup analyses by diagnosis, dose, or quality did not reveal significant differences.
Conclusions:
- MDI and wet nebulizer delivery of bronchodilators are equivalent for acute airflow obstruction.
- Spacer devices are recommended with MDIs for acute exacerbations.
- Choice of delivery method depends on expediency, cost, and staff availability.
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