Spacer compare well with nebulisers
Spacer devices are as good as nebulisers for delivering
inhaled beta2-agonists, says Dr Mark FitzGerald, Vancouver
General Hospital.
In a clinical review article published in the BMJ,
Dr FitzGerald looks at the evidence for different interventions for acute
asthma (2001; 323:841). He concludes that the use of spacer devices for
delivering inhaled medicines, short courses of oral corticosteroids and
the addition of ipratropium to beta2-agonist therapy are all
beneficial for the treatment of acute exacerbations of asthma. However,
he says trials that compared the use of spacer devices with nebulisers
excluded patients with life threatening asthma so data might not be applicable
to these patients.
He also identifies interventions that have less
supporting data but which are still likely to be beneficial in acute asthma.
These include continuous rather than intermittent delivery of bronchodilators,
oxygen supplementation and intravenous magnesium sulphate for patients
with more severe exacerbations. Asthma education to aid self-management
was also likely to be beneficial, he says.
Dr FitzGerald found varying amounts of evidence
for each intervention that he reviewed. All interventions, apart from
the use of oxygen in acute asthma, were supported by systematic reviews
or data from randomised controlled trials. Despite the lack of evidence
to support the use of oxygen, he concludes that experience and pathophysiology
suggest that its role in acute asthma is vital.
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