b-AGONISTS THROUGH METERED-DOSE INHALER WITH VALVED HOLDING CHAMBER VERSUS NEBULIZER FOR ACUTE EXACERBATION OF WHEEZING OR ASTHMA IN CHILDREN UNDER 5 YEARS OF AGE: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Results Six trials (n = 491) met criteria for inclusion. Patients who received b-agonists by MDI+VHC showed a significant decrease in the admission rate compared with those by nebulizer (OR, 0.42; 95% CI, 0.24-0.72; P = .002); this decrease was even more significant among children with moderate to severe exacerbations (OR, 0.27; 95% CI, 0.13-0.54; P = .0003). Finally, measure of severity (eg, clinical score) significantly improved in the group who received b-agonists by MDI+VHC in comparison to those who received nebulizer treatment (standardized mean difference, 0.44; 95% CI, 0.68 to 0.20; P = .0003).