Cates C J, Crilly J A, Rowe B H
Bushey Health Centre, Manor View Practice, London Road, Bushey, Watford, Hertfordshire, UK, WD23 2NN.
Cochrane Database Syst Rev. 2006 Apr 19(2):CD000052. doi: 10.1002/14651858.CD000052.pub2.
In acute asthma inhaled beta2-agonists are often administered to relieve bronchospasm by wet nebulisation, 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.
To assess the effects of holding chambers (spacers) compared to nebulisers for the delivery of beta2-agonists for acute asthma.
We last searched the Cochrane Airways Group trials register in January 2006 and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2005).
Randomised trials in adults and children (from two years of age) with asthma, where spacer beta2-agonist delivery was compared with wet nebulisation.
Two reviewers independently applied study inclusion criteria (one reviewer for the first version of the review), extracted the data and assessed trial quality. Missing data were obtained from the authors or estimated. Results are reported with 95% confidence intervals (CI).
This review has been updated in January 2006 and four new trials have been added. 2066 children and 614 adults are now included in 25 trials from emergency room and community settings. In addition, six trials on in-patients with acute asthma (213 children and 28 adults) have been reviewed. Method of delivery of beta2-agonist did not appear to affect hospital admission rates. In adults, the relative risk of admission for spacer versus nebuliser was 0.97 (95% CI 0.63 to 1.49). The relative risk for children was 0.65 (95% CI: 0.4 to 1.06). In children, length of stay in the emergency department was significantly shorter when the spacer was used, with a mean difference of -0.47 hours (95% CI: -0.58 to -0.37). 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 -7.6% baseline (95% CI: -9.9 to -5.3% baseline).
AUTHORS' CONCLUSIONS: Metered-dose inhalers with spacer produced outcomes that were at least equivalent to nebuliser delivery. Spacers may have some advantages compared to nebulisers for children with acute asthma.
在急性哮喘治疗中，吸入性β2激动剂常通过湿化雾化给药以缓解支气管痉挛，但一些人认为使用带有储雾罐（ spacer ）的定量吸入器同样有效。雾化器需要电源且需要定期维护，在社区环境中成本更高。
评估与雾化器相比，使用储雾罐（spacer）吸入β2激动剂治疗急性哮喘的效果。
我们最近一次检索Cochrane气道组试验注册库是在2006年1月，以及Cochrane对照试验中央注册库（《Cochrane图书馆》，2005年第4期）。
针对成人和儿童（两岁及以上）哮喘患者的随机试验，比较使用储雾罐吸入β2激动剂与湿化雾化的效果。
两名综述作者独立应用研究纳入标准（一名综述作者负责综述初稿），提取数据并评估试验质量。缺失数据向作者索取或进行估算。结果以95%置信区间（CI）报告。
本综述于2006年1月更新，新增了四项试验。目前来自急诊室和社区环境的25项试验纳入了2066名儿童和614名成人。此外，还对六项针对急性哮喘住院患者的试验（213名儿童和28名成人）进行了综述。β2激动剂的给药方式似乎不影响住院率。在成人中，使用储雾罐与雾化器相比的住院相对风险为0.97（95%CI：0.63至1.49）。儿童的相对风险为0.65（95%CI：0.4至1.06）。在儿童中，使用储雾罐时急诊留观时间显著缩短，平均差值为-0.47小时（95%CI：-0.58至-0.37）。两种给药方式下成人在急诊室的留观时间相似。两种给药方式下的峰值呼气流速和用力呼气量也相似。儿童使用储雾罐时心率较低，平均差值为基线的-7.6%（95%CI：-9.9至-5.3%基线）。
带储雾罐的定量吸入器产生的效果至少与雾化给药相当。对于急性哮喘儿童，储雾罐可能比雾化器有一些优势。
