Effectiveness of short-acting beta-2 agonists delivered by metered-dose inhaler with spacer versus nebulizer in acute asthma exacerbations: a systematic review and meta-analysis.
Adadja J et al., 2026 · 20 studies included
Summary
Twenty randomized trials, 2,235 participants aged at least two years; adult and pediatric acute asthma analyses.
Conclusion
No clear admission difference: RR 0.90 (95% CI 0.69–1.18). Reported outcome certainty ranged moderate to very low. Spacer delivery is reasonable when feasible; the absence of a significant difference is not proof of equivalence in near-fatal ventilated asthma. Select delivery by severity, cooperation and ability to receive an effective dose.