Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. A meta-analysis of randomized trials.
OBJECTIVE
To evaluate the efficacy of aerosolized adrenaline compared to inhaled beta(2) agonists in the treatment of acute asthma in the emergency setting.


METHODS
MEDLINE, EMBASE, CINAHI, and Cochrane databases, review articles, and references of included trials.


METHODS
Published (1966-2005) randomized controlled trials with pulmonary function as primary outcome.


RESULTS
Six studies met the criteria for inclusion in the meta-analysis. They included 161 adults and 121 children and adolescents. Patients who received inhaled adrenaline showed a nonsignificant improvement in pulmonary function (standardized mean difference = 0.20, 95% confidence interval -0.22 to 0.63, P = .35) compared to patients getting inhaled beta(2) agonists. Moderate heterogeneity was identified between studies (I(2) = 47.2%). Homogeneity was achieved when studies that reported pulmonary function were stratified by intensity of adrenaline treatment. The use of more than 2 mg of adrenaline per dose was equivalent to 5 mg of salbutamol or terbutaline per dose. On the contrary, 2 mg or less of adrenaline per dose was inferior to 2.5 or 5 mg of salbutamol per dose. In addition, there were no differences in heart rate and Pao(2) between treatments.


CONCLUSIONS
There was no statistically significant benefit of nebulized adrenaline over salbutamol or terbutaline in the treatment of children and adults with moderate-severe acute asthma.
Rodrigo
Gustavo J
GJ
Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay. gurodrig@adinet.com
Nannini
Luis J
LJ
D000208:Acute Disease; D000280:Administration, Inhalation; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000328:Adult; D000336:Aerosols; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D004638:Emergency Treatment; D004837:Epinephrine / Q000008:administration & dosage*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests
D000318:Adrenergic beta-Agonists; D000336:Aerosols; D004837:Epinephrine