Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children

Rodriguez-Martinez CE, Sossa M, Lozano JM

Published Online:

February 16, 2011

The aim of this review was to compare the response to inhaled beta-2 agonists delivered through a metered-dose inhaler (MDI) attached to home-made spacers, compared with beta-2 agonists delivered through a MDI attached to commercially produced spacers in children with acute exacerbations of wheezing or asthma. Six randomized clinical trials (RCTs) with 658 participants met the inclusion criteria of the review. Overall, this review fails to identify a difference between these two delivery methods for delivering bronchodilator therapy to children with acute asthma or lower airways obstruction attacks. However, given the small total sample and wide confidence intervals, equivalence between the treatments cannot be claimed.

Abstract (click to read)

Background:

Strong evidence supports the use of metered-dose inhalers combined with a spacer for delivering rapid-acting inhaled beta-2 agonists in the treatment of acute exacerbations of asthma in children. The high cost and lack of availability of commercially produced spacers however, have limited their use in developing countries.

Objectives:

The aim of this review was to compare the response to inhaled beta-2 agonists delivered through metered-dose inhaler using home-made spacers, to the use of commercially produced spacers, in children with acute exacerbations of wheezing or asthma.

Search strategy:

We searched the Cochrane Airwyas Group Register (up to August 2010), Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE , EMBASE, CINHAL, LILACS and reference lists of included studies. We contacted authors and known experts in the field, and approached pharmaceutical companies that manufacture inhalation spacers to identify additional published or unpublished data. No language restrictions were applied.

Selection criteria:

Trials comparing treatment with rapid acting beta 2-agonists delivered through a MDI attached to home-made spacers, versus the same bronchodilator therapy delivered with a MDI and commercially produced spacers, in children under 18 years with acute exacerbations of wheezing or asthma.

Data collection and analysis:

Two review authors independently extracted the data and assessed trial quality. Missing data were obtained from the authors or estimated from information available in published reports.

Main results:

Six trials with 658 participants met the inclusion criteria. At the time of this review, five trials were published in full text, and one study was available in abstract form only. No significant differences were demonstrated between the two delivery methods in terms of the need for hospital admission (RR 1.00, 95% CI 0.63 to 1.59), change in oxygen saturation (SMD -0.03, 95% CI -0.39 to 0.33), PEFR (SMD 0.04, 95% CI -0.72 to 0.80), clinical score (WMD 0.00, 95% CI -0.37 to 0.37), in terms of need for additional treatment (RR 1.18, 95% CI 0.84 to 1.65), or regarding change in heart rate per minute (SMD 0.09, 95% CI -0.24 to 0.42).

Authors' conclusions:

Overall, this review did not identify a statistically significant difference between these two methods for delivering bronchodilator therapy to children with acute asthma or lower airways obstruction attacks. Care should be taken in the interpretation and applicability of our results because of the small number of RCTs along with few events available meeting the criteria for inclusion in the review, absence of the primary outcome of interest and other clinically important outcomes in the majority of included studies. The possible need for a face-mask in younger children using home-made spacers should also be considered in practice.

This record should be cited as:

Rodriguez-Martinez CE, Sossa M, Lozano JM. Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005536. DOI: 10.1002/14651858.CD005536.pub2

Assessed as up to date:

August 18, 2010

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Primary Review Group:

Airways Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective are homemade spacers (plastic cold-drink bottles, polystyrene cups, plastic zip-up bags) in delivering bronchodilator therapy to children with acute exacerbations of wheezing or asthma?

Bottom line:

The review did not identify a difference between commercially produced and homemade spacers for delivering beta 2 agonists through a metered-dose inhaler (MDI) to children under 18 years with acute exacerbations of wheezing or asthma. The outcomes studied included hospital admissions, change in oxygen saturation, clinical scores, change in peak expiratory flow rate, and need for additional treatment.

Caveat:

Care should be taken in the interpretation and applicability of these results because of the small number of randomised controlled trials, along with few events available meeting the criteria for inclusion in the review, and absence of the primary outcome of interest and other clinically important outcomes in the majority of the included studies. Given the small total sample and wide confidence intervals, equivalence between the treatments cannot be claimed.

Context:

Asthma is a major cause of childhood morbidity¹ and disability² with acute exacerbations of the disease being a common reason for emergency department admissions and hospital admissions.³ Inhaled therapy using a MDI with attached spacer, has been increasingly recognised as the optimal method of delivering rapid acting beta 2 agonists for acute exacerbation of wheezing or asthma. 1. Braman SS. Chest 2006;130:4S-12S. 2. Newacheck PW et al. Archives of Paediatric and Adolescent Medicine 2000;154:287-293. 3. Akinbami LJ et al. Paediatrics 2002; 110:315-322.

Cochrane Systematic Review:

Rodriguez C et al. Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children. Cochrane Reviews 2008, Issue 2. Art. No. :CD005536. DOI :10. 1002/14651858. CD005536.pub2. This review contains 6 trials involving 658 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Asthma topics:

Treating with Medications > Asthma Attacks > Beta agonists

Health topics:

Lungs & airways > Asthma (acute) > Bronchodilators

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children

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