Turner M O, Patel A, Ginsburg S, FitzGerald J M
Department of Medicine, University of British Columbia, Vancouver.
Arch Intern Med. 1997;157(15):1736-44.
To compare the effect of bronchodilator delivery by use of a metered-dose inhaler (MDI) or wet nebulizer on objective measurements of acute airflow obstruction in adult patients.
Published and unpublished research was identified by MEDLINE searches for articles published from 1966 to 1994, review of scientific citations, review of article bibliographies, communication with experts in the area of asthma therapy and aerosol delivery, primary investigators, and a manufacturer of spacer devices. Eighteen studies were selected from 159 potentially relevant articles by independent review in triplicate. Selection criteria included randomized trials that compared bronchodilator delivery by use of an MDI and wet nebulizer in adults with acute exacerbations of asthma or chronic obstructive pulmonary disease who were treated in an emergency department or a hospital. Data for patient characteristics, study setting, bronchodilator doses, outcomes, and methodological quality were independently extracted.
Twelve studies with a total of 507 patients had sufficient data to calculate an effect size (in SD units) for improvement in airflow obstruction after bronchodilator delivery. All but 2 studies used spacer devices with the MDI. The overall treatment effect size was -0.02 (95% confidence interval [CI], -0.20 to 0.16) that favored the MDI, but the magnitude of the effect size was not clinically or statistically significant. No significant effect was observed in the subgroup analyses that compared the diagnosis: asthma, -0.17 (CI, -0.41 to 0.07) compared with chronic obstructive pulmonary disease, 0.23 (CI, -0.35 to 0.81); bronchodilator dose; or methodological quality. The results of a sensitivity analysis that included 5 of 6 excluded studies supported the findings from the primary analysis: 0.05 (CI, -0.11 to 0.20).
Bronchodilator delivery by means of an MDI or wet nebulizer is equivalent in the acute treatment of adults with airflow obstruction. Spacer devices were used for bronchodilator delivery with an MDI in most studies and are recommended for the treatment of acute airflow obstruction. The choice of the delivery method will depend on the need for expedient treatment, availability of staff, consideration of costs, and findings from studies designed to evaluate treatment effects from larger than standard doses of bronchodilators delivered by use of an MDI.
比较使用定量吸入器（MDI）或湿式雾化器给予支气管扩张剂对成年患者急性气流阻塞客观测量指标的影响。
通过MEDLINE检索1966年至1994年发表的文章、查阅科学引文、查看文章参考文献、与哮喘治疗和气溶胶给药领域的专家、主要研究者以及一种储雾罐装置制造商进行沟通，来识别已发表和未发表的研究。通过独立的三轮评审，从159篇可能相关的文章中选出18项研究。选择标准包括随机试验，该试验比较了在急诊科或医院接受治疗的患有哮喘急性加重或慢性阻塞性肺疾病的成年人中，使用MDI和湿式雾化器给予支气管扩张剂的情况。独立提取患者特征、研究环境、支气管扩张剂剂量、结果和方法学质量的数据。
12项研究共纳入507例患者，有足够的数据来计算支气管扩张剂给药后气流阻塞改善的效应量（以标准差单位表示）。除2项研究外，所有研究均将储雾罐装置与MDI一起使用。总体治疗效应量为-0.02（95%置信区间[CI]，-0.20至0.16），支持MDI，但效应量的大小在临床或统计学上均无显著意义。在比较诊断的亚组分析中未观察到显著效应：哮喘患者为-0.17（CI，-0.41至0.07），慢性阻塞性肺疾病患者为0.23（CI，-0.35至0.81）；支气管扩张剂剂量；或方法学质量。纳入6项排除研究中的5项的敏感性分析结果支持了主要分析的结果：0.05（CI，-0.11至0.20）。
在成年气流阻塞患者的急性治疗中，通过MDI或湿式雾化器给予支气管扩张剂效果相当。在大多数研究中，储雾罐装置与MDI一起用于给予支气管扩张剂，建议用于急性气流阻塞的治疗。给药方法的选择将取决于快速治疗的需求、工作人员的可用性、成本考虑以及旨在评估使用MDI给予大于标准剂量支气管扩张剂的治疗效果的研究结果。
