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Metered‐dose inhalers vs. nebulization for the delivery of albuterol in pediatric asthma exacerbations: a systematic review with meta-analysis
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  • Laura Payares-Salamanca,
  • Sandra Contreras-Arrieta,
  • Victor Florez-Garcia,
  • Alexander Barrios-Sanjuanelo,
  • Ivan Stand-Niño,
  • Carlos Rodriguez-Martinez
Laura Payares-Salamanca
Universidad del Norte
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Sandra Contreras-Arrieta
Universidad del Sinu Elias Bechara Zainum Escuela de Medicina
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Victor Florez-Garcia
Universidad del Norte
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Alexander Barrios-Sanjuanelo
Universidad del Norte
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Ivan Stand-Niño
Universidad del Norte
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Carlos Rodriguez-Martinez
School of Medicine, Universidad El Bosque
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Abstract

Objectives: Although albuterol, the most frequently used bronchodilator, has been traditionally and generally delivered via nebulization (NEB) with compressed air/oxygen, the benefits of metered‐dose inhalers with a spacer (MDI+S) have been widely recognized as an alternative method for albuterol administration. The aim of this systematic review was to compare the response to albuterol delivered through NEB with albuterol delivered through MDI+S in pediatric patients with asthma exacerbations. Methods: We conducted an electronic search in MEDLINE/PubMed, EMBASE, Ovid and ClinicalTrials. To be included in the review, a study had to a randomized clinical trial comparing albuterol delivered via NEB versus MDI+S; and had to report the rate of hospital admission (primary outcome), or any of the following secondary outcomes: oxygen arterial saturation, heart rate (HR), respiratory rate, the pulmonary index score (PIS), adverse effects, and need for additional treatment. Results: Fifteen studies (n=2057) met inclusion criteria. No significant differences were found between the two albuterol delivery methods in terms of hospital admission (RR 0.89; 95% CI 0.55 to 1.46; I2=32%; p=0.65). There was a significant reduction in the PIS score (MD -0.63; 95% CI -0.91 to -0.35; I2=0%; p < 0.00001), and a significantly smaller increase in HR (better) (MD -6.47; 95% CI -11.69 to -1.25; I2=0%; p=0.02) when albuterol was delivered through MDI+S than when it was delivered through NEB. Conclusions: This review showed a significant reduction in the PIS and a significantly smaller increase in HR when albuterol was delivered through MDI+S than when it was delivered through NEB.

Peer review status:ACCEPTED

16 Jun 2020Submitted to Pediatric Pulmonology
17 Jun 2020Submission Checks Completed
17 Jun 2020Assigned to Editor
25 Jun 2020Reviewer(s) Assigned
27 Jul 2020Review(s) Completed, Editorial Evaluation Pending
14 Aug 20201st Revision Received
17 Aug 2020Submission Checks Completed
17 Aug 2020Assigned to Editor
17 Aug 2020Reviewer(s) Assigned
11 Sep 2020Review(s) Completed, Editorial Evaluation Pending
14 Sep 2020Editorial Decision: Accept