Commercial versus home‐made spacers in delivering bronchodilator therapy for acute therapy in children

1-25 ; Background Strong evidence supports the use of metered‐dose inhalers combined with a spacer for delivering rapid‐acting inhaled beta‐2 agonists in the treatment of acute exacerbations of asthma in children. The high cost and lack of availability of commercially produced spacers however, have limited their use in developing countries. Objectives The aim of this review was to compare the response to inhaled beta‐2 agonists delivered through metered‐dose inhaler using home‐made spacers, to the use of commercially produced spacers, in children with acute exacerbations of wheezing or asthma. Search methods We searched the Cochrane Airwyas Group Register (up to August 2010), Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE , EMBASE, CINHAL, LILACS and reference lists of included studies. We contacted authors and known experts in the field, and approached pharmaceutical companies that manufacture inhalation spacers to identify additional published or unpublished data. No language restrictions were applied. Selection criteria Trials comparing treatment with rapid acting beta 2‐agonists delivered through a MDI attached to home‐made spacers, versus the same bronchodilator therapy delivered with a MDI and commercially produced spacers, in children under 18 years with acute exacerbations of wheezing or asthma. Data collection and analysis Two review authors independently extracted the data and assessed trial quality. Missing data were obtained from the authors or estimated from information available in published reports. Main results Six trials with 658 participants met the inclusion criteria. At the time of this review, five trials were published in full text, and one study was available in abstract form only. No significant differences were demonstrated between the two delivery methods in terms of the need for hospital admission (RR 1.00, 95% CI 0.63 to 1.59), change in oxygen saturation (SMD ‐0.03, 95% CI ‐0.39 to 0.33), PEFR (SMD 0.04, 95% CI ‐0.72 to 0.80), clinical score ...