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Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: Effects on Pulmonary Function

Sixty-two articles were identified in the initial search. Of these, reviewers found that 16 articles were potentially eligible. Most of the others were excluded because they were not clinical trials of patients with acute asthma. The reasons for subsequent exclusion were nonrandomized trials (n = 6),зД”20-22 only a continuous nebulization group included in the study (n = 1), only pediatric patients included in the study (n = 2),” and non-acute asthma patients included in the study (n = 1). Finally, six articles were selected for inclusion in the meta-analysis. Four studies were from the United States, one was from Canada, and one was from Tunisia. The к statistic for inter-rater agreement on the inclusion or exclusion of potential trials was 1.0. All studies reported pulmonary function measures, five reported heart rates, two reported admission rates, and two reported serum potassium concentrations. Table 1 shows the characteristics of the trials included in this review this flovent inhaler.This review analyzed 393 adults who were included in six trials. One study compared nebulized albuterol at high doses (ie, 7.5 mg) or standard doses (ie, 2.5 mg) given either continuously for 1 h, or intermittently every hour for 2 h. The nebulized doses of albuterol in the first hour ranged between 2.5 and 16 mg. All studies reported the use of systemic corticosteroids, and four studies included acute severe asthma patients (pulmonary function, < 50% of predicted), In the six selected studies, a variety of pulmonary function tests was recorded over the ED stay. Four studies recorded FEV1 as percent predicted, three recorded absolute FEV1, and two recorded both percent predicted and absolute PEF. The results were pooled at 1 h and at 2 to 3 h after the start of treatment. No significant differences were demonstrated between the two delivery methods in terms of pulmonary function measurements at 1 h and at 2 to 3 h.
Table 1—Summary of Included Trials

Trial Patients, No. JadadScore Baseline Severity Drug (Dose) Continuous Nebulizer
Colacone et al 42 2 < 50% FEVj Albuterol (10 mg over 2 h) Large-volume nebulizer
Lin et al 38 3 < 50% PEF Albuterol (30 mg over 110 min) HEART nebulizer
Rudnitsky et al 99 2 Moderate to severe Albuterol (10 mg over 70 min) HEART nebulizer
Reisner et al 20 2 < 60% PEF Albuterol (7.5 mg/h) Conventional nebulizer with infusion pump
Shrestha et al 152 2 < 40% FEV1 Albuterol (2.5 mg or 7.5 mg over 2 h) Frequent refilling of conventional nebulizer
Besbes-Ouanes et al 42 3 < 50% PEF Albuterol (27.5 mg over 6 h) Frequent refilling of conventional nebulizer