Grade table 7

Question: Should salbutamol via spacer versus salbutamol via nebulized be used for acute asthma in primary care?

Settings: Emergency department or community

Bibliography: Cates CJ et al. (6)

Quality assessmentSummary of findingsImportance
No of patientsEffectsQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsSalbutamol via spacerSalbutamol via nebulizerRelative (95% CI)Absolute
Hospital admission – adults
8randomised trialsserious1no serious inconsistencyserious2serious3none30/269 (11.2%)29/255 (11.4%)RR 0.97 (0.63 to 1.49)3 fewer per 1000 (from 42 fewer to 56 more)⊕○○○
VERY LOW		IMPORTANT
Duration in emergency department (hours) – adults (better indicated by lower values)
2randomised trialsserious1no serious inconsistencyserious2serious3none6468–MD 0.02 higher (0.4 lower to 0.44 higher)⊕○○○
VERY LOW		IMPORTANT
Hospital admission – children
8randomised trialsseriousno serious inconsistencyseriousseriousnone29/326 (8.9%)38/286 (13.3%)RR 0.72 (0.47 to 1.09)37 fewer per 1000 (from 70 fewer to 12 more)⊕○○○
VERY LOW		IMPORTANT
Duration in emergency department (hours) – children (better indicated by lower values)
3randomised trialsserious1no serious inconsistency4serious2no serious imprecisionnone196200–MD 0.53 lower (0.62 to 0.44 lower)5⊕⊕○○
LOW		IMPORTANT
1

Allocation unclear and not all studies were double-blind.

2

Most studies carried out in the emergency department.

3

Wide CIs include clinically significant differences in both directions.

4

Statistically heterogeneity, but all studies showed clinically important reduction in time in the emergency department using spacers.

5

Mean duration for children in the emergency department on nebulizer was 1.5 hours.

From: Annex 4, Grade tables

Cover of Prevention and Control of Noncommunicable Diseases
Prevention and Control of Noncommunicable Diseases: Guidelines for Primary Health Care in Low Resource Settings.
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