{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:31:10Z","timestamp":1785519070482,"version":"3.56.0"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T00:00:00Z","timestamp":1600992000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The benefits of metered\u2010dose inhalers with a spacer (MDI+S) have increasingly been recognized as an alternative method of albuterol administration for treating pediatric asthma exacerbations. The aim of this systematic review was to compare the response to albuterol delivered through nebulization (NEB) with albuterol delivered through MDI+S in pediatric patients with asthma exacerbations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted an electronic search in MEDLINE\/PubMed, EMBASE, Ovid, and ClinicalTrials. To be included in the review, a study had to a randomized clinical trial comparing albuterol delivered via NEB versus MDI+S; and had to report the rate of hospital admission (primary outcome), or any of the following secondary outcomes: oxygen arterial saturation, heart rate (HR), respiratory rate (RR), the pulmonary index score (PIS), adverse effects, and need for additional treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifteen studies (<jats:italic>n<\/jats:italic>\u2009=\u20092057) met inclusion criteria. No significant differences were found between the two albuterol delivery methods in terms of hospital admission (relative risk, 0.89; 95% confidence interval [CI], 0.55\u20131.46; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200932%; <jats:italic>p<\/jats:italic>\u2009=\u2009.65). There was a significant reduction in the PIS score (mean difference [MD], \u22120.63; 95% CI, \u22120.91 to \u22120.35; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.00001), and a significantly smaller increase in HR (better; MD \u22126.47; 95% CI, \u221211.69 to \u22121.25; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%; <jats:italic>p<\/jats:italic>\u2009=\u2009.02) when albuterol was delivered through MDI+S than when it was delivered through NEB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This review, an update of a previously\u2010published meta\u2010analysis, showed a significant reduction in the PIS and a significantly smaller increase in HR when albuterol was delivered through MDI+S than when it was delivered through NEB.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.25077","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T18:30:10Z","timestamp":1600367410000},"page":"3268-3278","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Metered\u2010dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta\u2010analysis"],"prefix":"10.1002","volume":"55","author":[{"given":"Laura","family":"Payares\u2010Salamanca","sequence":"first","affiliation":[{"name":"Department of Pediatrics, School of Medicine Universidad del Norte  Barranquilla Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Contreras\u2010Arrieta","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Universidad de los Andes  Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Florez\u2010Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Public Health Universidad del Norte  Barranquilla Colombia"},{"name":"Environmental Health Sciences, Joseph J. Ziber School of Public Health University of Wisconsin\u2010 Milwaukee  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Barrios\u2010Sanjuanelo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine Universidad del Norte  Barranquilla Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Stand\u2010Ni\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pulmonology, School of Medicine Universidad del Norte  Barranquilla Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2560-6693","authenticated-orcid":false,"given":"Carlos E.","family":"Rodriguez\u2010Martinez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine Universidad Nacional de Colombia  Bogota Colombia"},{"name":"Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine Universidad El Bosque  Bogota Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.14.0170"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40733-016-0029-3"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2005.06.012"},{"issue":"6","key":"e_1_2_7_5_1","first-page":"497","article-title":"Comparative efficacy of jet nebulizer and metered dose inhaler with spacer device in the treatment of acute asthma","volume":"34","author":"Batra V","year":"1997","journal-title":"Indian Pediatr"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(00)90013-1"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2004.04.007"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-2963"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/cem.2016.344"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.3111\/13696998.2012.674587"},{"key":"e_1_2_7_11_1","first-page":"Cd000052","article-title":"Holding chambers (spacers) versus nebulisers for beta\u2010agonist treatment of acute asthma","volume":"9","author":"Cates CJ","year":"2013","journal-title":"Cochrane Data System Rev"},{"issue":"4","key":"e_1_2_7_12_1","first-page":"265","article-title":"MDI with DIY spacer versus nebulizer for bronchodilator therapy in children admitted with asthmatic attack","volume":"99","author":"Leelathipkul L","year":"2016","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/02770903.2016.1185114"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2018.03.002"},{"key":"e_1_2_7_15_1","unstructured":"https:\/\/www.crd.york.ac.uk\/PROSPERO\/"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-4-1"},{"key":"e_1_2_7_17_1","first-page":"1","article-title":"Pediatric acute asthma scoring systems: a systematic review and survey of UK practice","author":"Chacko J","year":"2020","journal-title":"JACEP Open"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604"},{"key":"e_1_2_7_19_1","volume-title":"Users' Guides to the Medical Literature: A Manual for Evidence\u2010Based Clinical Practice","author":"Guyatt GH","year":"2015"},{"key":"e_1_2_7_20_1","unstructured":"Review Manager Web (RevMan Web)2020.The Cochrane Collaboration 2019 available atrevman.cochrane.org. 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