Spacers and nebulisers for the delivery of beta-agonists in non-life-threatening acute asthma.
BACKGROUND
In asthma exacerbations, higher doses of inhaled beta-agonists are used to overcome acute bronchoconstriction. Traditionally, wet nebulisation has been used, but metered-dose inhaler with a spacer device is an alternative delivery method.


OBJECTIVE
To compare the clinical outcomes in adults and children with acute asthma, presenting in emergency departments or in the community, who have been randomised to beta-agonists given by two different delivery.


METHODS
a metered-dose inhaler with spacer or a nebuliser.


RESULTS
A Cochrane review has found no important differences between the two delivery methods in adults. Children may suffer fewer side effects with spacer delivery.


CONCLUSIONS
Individual response to treatment cannot be predicted, but many studies overcame this problem by using frequent repeated doses of beta-agonists (one respule via nebuliser or four separate actuations of a metered-dose inhaler through a spacer) every 10-15 min, titrated against the clinical response of the patients. This approach is advocated in clinical practice.
Cates
Christopher
C
Manor View Practice, Bushey Health Centre, London Road, Bushey, Hertfordshire WD23 2NN, UK. chriscates@msn.com
D000208:Acute Disease; D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D004630:Emergencies; D006760:Hospitalization; D006801:Humans; D036503:Inhalation Spacers; D009330:Nebulizers and Vaporizers; D016032:Randomized Controlled Trials as Topic
D000318:Adrenergic beta-Agonists