Thus, these findings argue against the routine use of continuous nebulization in the ED treatment of patients with acute asthma, and the decision to use one of these nebulization methods should be based on logistical and cost considerations. Overall, this review supports the equivalence of continuous and intermittent albuterol nebulization in the acute treatment of nonventilated adult asthma patients. Also, patients who received continuous nebulization showed lower pulse rates, and a decrease of serum potassium concentration compared to patients receiving the same P-agonist via intermittent nebuli-zation. However, these findings are based on only five trials and two trials, respectively. Consequently, this information should be interpreted with caution, Since all studies reviewed excluded patients with life-threatening asthma (for example those patients who have been considered for ventilation), these results should not be extrapolated to this group.
This study met most of the methodological criteria that have been suggested for scientific reviews. The patients had the typical features of patients with moderately to severely acute asthma when they presented for care to an ED. All of the included trials were randomized and placebo-controlled. Although sensitivity analysis and the tests of homogeneity suggest that the results of this meta-analysis were relatively robust, this review is limited by the number of selected trials and the quality of the data. Even if the number and size of the pooled studies were small, the exclusion of trials with lower reported methodological quality did not affect the conclusions. Clearly, the current conclusions may be seriously modified by the results of larger trials. ventolin inhaler
In summary, for adults seen and assessed for acute exacerbations of asthma, this review found no significant differences between the two methods for treatment delivery. Consequently, the choice of delivery method should reflect practice situations and economic considerations. However, the findings are based on a reduced number of trials, and these conclusions may not apply to patients with life-threatening asthma.