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Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: Sensitivity Analyses

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: Sensitivity AnalysesMore specifically, there were no significant group differences in the SMD observed after 1 h of treatment (SMD, -0.15; 95% CI, -0.35 to 0.05) and after 2 to 3 h of treatment (SMD, -0.19; 95% CI, -0.39 to 0.01) [Fig 1]. No significant heterogeneity was demonstrated (p > 0.5). In the same way, the four trials reporting responses to treatment as the change in the percentage predicted of FEV1> did not show group differences after 1 h of treatment (WMD, -1.73; 95% CI, -8.51 to 5.05) and after 2 to 3 h of treatment (WMD, -2.18; 95% CI, -6.24 to 1.88).
Side Effects and Hospital Admissions
Five studies reported the final heart rate. At the end of treatment, there was a significant, but small, decrease in pulse rate when continuous neb-ulization was administered (WMD, -6.82; 95% CI, -8.67 to -3.90 beats/min; x2, 2.55; degrees of freedom [df], 4; p = 0.6) [Fig 2]. Additionally, only two studies reported final serum potassium concentrations.The analysis showed a significant decrease with the use of intermittent nebulization (3.87 vs 3.76 mEq/L, respectively; WMD, 0.12; 95% CI, 0.24 to 0.01 mmol/L; x2, 0.5; df, 2; p = 0.8). Finally, two studies reported hospital admissions, and no significant differences were identified between patients treated with continuous or intermittent nebu-lization at the end of the study period (relative risk, 0.68; 95% CI, 0.33 to 1.38; x 2.06; df, 1; p = 0.2) read only birth control online. Side effects such as tremor and palpitations were reported so infrequently that they could not be considered in this review.
The robustness of the findings to different assumptions was analyzed in sensitivity analyses. Three subgroup analyses were specified as follows a priori: severity of airway obstruction (pulmonary function, < 50% vs > 50% of predicted); methodological quality (Jadad et al criteria, > 3 vs < 3); and (P-agonist dose (> 5 vs < 5 mg/h of albuterol). Four studies included patients with severe asthma, and two included patients with moderate asthma.
Fig1
Figure 1. Pooled SMD of the change in lung function 1 h and 2 to 3 h after the start of treatment. The width of the horizontal line represents the 95% CI around a point estimate (squares). The size of the point estimate represents the relative weight (% weight) of each trial in the pooled summary estimate (diamond). CN = continuous nebulization; IN = intermittent nebulization.
Fig2
Figure 2. Pooled WMD of heart rate at the end of treatment. The width of horizontal line represents 95% the CI around a point estimate (squares). The size of the point estimate represents the relative weight (% weight) of each trial in the pooled summary estimate (diamond). See the legend of Figure 1 for abbreviations not used in the text.