COMPARISON OF TWO INHALATIONAL TECHNIQUES FOR BRONCHODILATOR ADMINISTRATION IN CHILDREN AND ADOLESCENTS WITH ACUTE ASTHMA CRISIS: A META-ANALYSIS

ABSTRACT Objective: To compare the efficacy of pediatric asthma treatment by nebulizer and metered-dose inhaler with the use of a spacer (MDI-spacer) in rescue techniques for asthmatic patients assisted at pediatric emergency units. Data sources: A systematic review was conducted to identify the most relevant randomized controlled trials comparing the administration of a bronchodilator (β-2 agonist) by two inhalation techniques (nebulization and MDI-spacer) to treat asthma in children at pediatric emergency units. The following databases were searched: PubMed, Scientific Electronic Library Online (SciELO), and ScienceDirect. Two researchers independently applied the eligibility criteria, and only randomized controlled trials that compared both inhalation techniques (nebulization and MDI-spacer) for asthma treatment at pediatric emergency units were included. Data synthesis: 212 articles were pre-selected, of which only nine met the eligibility criteria and were included in meta-analysis. Results show no differences between inhalation techniques for any of the four outcomes analyzed: heart rate (difference - Df: 1.99 [95% confidence interval - 95%CI -2.01-6.00]); respiratory rate (Df: 0.11 [95%CI -1.35-1.56]); O2 saturation (Df: -0.01 [95%CI -0.50-0.48]); and asthma score (Df: 0.06 [95%CI -0,26-0.38]). Conclusions: The findings demonstrate no differences in cardiorespiratory frequency, O2 saturation, and asthma scores upon administration of β-2 agonist by both inhalation techniques (nebulization and MDI-spacer) to asthmatic patients assisted at pediatric emergency units.

摘要
目的：比较雾化吸入器与带储雾罐的定量吸入器（metered-dose inhaler with spacer, MDI-spacer）在儿科急诊哮喘患者急救中的治疗效果。
资料来源：本研究开展系统评价（systematic review），以筛选对比两种吸入技术（雾化吸入与MDI-储雾罐给药）用于儿科急诊哮喘患儿支气管舒张剂（β₂受体激动剂，β-2 agonist）给药疗效的随机对照试验（randomized controlled trial, RCT）。检索数据库包括PubMed、科学电子图书馆在线（Scientific Electronic Library Online, SciELO）及ScienceDirect。由两名研究者独立执行纳入合格标准，仅纳入在儿科急诊场景下比较两种吸入技术治疗哮喘的随机对照试验。
数据合成：预筛选共获得212篇文献，最终仅9篇符合纳入标准并被纳入荟萃分析（meta-analysis）。结果显示，在四项分析结局指标中两种吸入技术均无显著差异：心率（差值Df=1.99，95%置信区间95%CI：-2.01~6.00）、呼吸频率（Df=0.11，95%CI：-1.35~1.56）、血氧饱和度（Df=-0.01，95%CI：-0.50~0.48）及哮喘评分（Df=0.06，95%CI：-0.26~0.38）。
结论：研究结果表明，在儿科急诊就诊的哮喘患者中，采用两种吸入技术（雾化吸入与MDI-储雾罐给药）给予β₂受体激动剂后，患者的心肺频率、血氧饱和度及哮喘评分均无显著差异。