Spacers and nebulisers for the delivery of beta-agonists in non-life-threatening acute asthma

Background: In asthma exacerbations, higher doses of inhaled beta-agonists are used to overcome acute bronchoconstriction. Traditionally, wet nebulisation has been used, but metered-dose inhaler with a spacer device is an alternative delivery method. Objective: To compare the clinical outcomes in adults and children, with acute asthma, presenting in emergency departments or in the community, who have been randomised to beta-agonists given by two different delivery. Methods: a metered-dose inhaler with spacer or a nebuliser. Results: A Cochrane review has found no important differences between the two delivery methods in adults. Children may suffer fewer side effects with spacer delivery. Conclusions: Individual response to treatment cannot be predicted, but many studies overcame this problem by using frequent repeated doses of beta-agonists (one respule via nebuliser or four separate actuations of a metered-dose inhaler through a spacer) every 10-15 min, titrated against the clinical response of the patients., This approach is advocated in clinical practice. (C) 2003 Elsevier Science Ltd. All rights reserved.