Figures
- Figure 1
Screen shot of a PubMed search using the term "spacers and acute asthma".
- Figure 2
Screen shot of the abstract of the Cochrane review in PubMed.
- Figure 3
Risk of bias summary for Cochrane review comparing pMDI and spacer to nebulisers to deliver β2-agonists to adults and children with acute asthma. The red circle indicates high risk of bias, the green circle low risk and the yellow circle indicates that the risk is unclear as judged by the authors of the Cochrane Review. Figure reproduced and modified from [1] with the publisher’s permission.
- Figure 4
Forest plot showing the number of adults (at the top) and children (lower down) who were admitted to hospital after treatment in the emergency department for an asthma exacerbation. Figure reproduced and modified from [1] with the publisher’s permission.
- Figure 5
For every 100 children treated with nebuliser for acute asthma, there were 11 children admitted to hospital.
- Figure 6
If all 100 children were treated with pMDI and spacer we expect that 8 would be admitted to hospital (95% CI 5–12).
- Figure 7
Forest plot showing duration in the emergency department (in minutes). Figure reproduced and modified from [1] with the publisher’s permission.
Tables
- Table 1 Summary of findings for children: multiple treatment of β2-agonist via spacer (chamber) compared with nebuliser for children with acute asthma
Outcomes Illustrative comparative risks# (95% CI) Relative effect (95% CI) No of Participants (studies) Quality of the evidence (GRADE) Comments Assumed risk: nebuliser Corresponding risk: multiple treatment of β2-agonist via spacer (chamber) Hospital admission 110 per 1000 78 per 1000 (52 to 119) RR 0.71 (0.47 to 1.08) 757 (9 studies) ++ Low¶,§ Large increases in the proportion of children admitted to hospital on spacer in comparison to nebuliser are ruled out by this 95% confidence interval. Duration in emergency department min The mean duration in emergency department (minutes) in the control groups was 103 minutes The mean duration in emergency department (minutes) in the intervention groups was 33 minutes shorter (43 minutes shorter to 24 minutes shorter) 396 (3 studies) +++ Moderate¶ There was a consistent direction of shortening of time in the emergency department in all three studies and, although the size of this effect varied between studies (I2 = 66%), we felt that the mean difference was important in all studies. Final rise in FEV1 % pred Control groups: 27% predicted at baseline Intervention groups: 0.92% higher (4.96% lower to 6.79% higher) 48 (2 studies) ++ Low¶,§ Mean rise in pulse rate % baseline Control groups: 7% rise from baseline Intervention groups: 5.62% lower (7.52% to 3.72% lower) 670 (9 studies) +++ Moderate¶ Number of participants developing tremor 142 per 1000 91 per 1000 (62 to 135) RR 0.64 (0.44 to 0.95) 254 (4 studies) +++ Moderate¶ #: The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes, the corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI); ¶: Mostly open label studies; §: Wide confidence intervals. Patient or population: children with acute asthma; settings: community or emergency department; intervention: multiple treatments with β2-agonist via spacer (chamber); comparison: multiple treatments with β2-agonist via nebuliser. GRADE Working Group grades of evidence are as follows: high quality: further research is very unlikely to change our confidence in the estimate of effect; moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; very low quality: we are very uncertain about the estimate.
