HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Travers, A. H. Articles by Camargo, C. A. Search for Related Content PubMed PubMed Citation Articles by Travers, A. H. Articles by Camargo, C. A., Jr

The Effectiveness of IV ß-Agonists in Treating Patients With Acute Asthma in the Emergency Department^*

A Meta-analysis

^* From the Division of Emergency Medicine (Drs. Travers and Rowe) and Department of Radiology (Dr. Barker), University of Alberta and Capital Health Authority, Edmonton, AB, Canada; Respiratory Care Department (Mr. Jones), University of Texas, San Antonio, TX; and the Department of Emergency Medicine (Dr. Camargo), Massachusetts General Hospital Boston, MA.

Correspondence to: Andrew Travers, MD, MSc, Division of Emergency Medicine, University of Alberta, 1G1.50 WMC, 8440-112th St, Edmonton, AB, T6G 2B7 Canada; e-mail: ahtravers{at}shaw.ca

Objectives: To determine the benefit of IV ß₂-agonists for severe acute asthma treated in the emergency department (ED).

Methods: Randomized controlled trials were identified using EMBASE, MEDLINE, and CINAHL; the Cochrane Airways Review Group database; hand searching; bibliographies; pharmaceutical companies; and author contact. Studies where IV ß₂-agonists were compared to placebo and/or existing standards of care were considered. Where appropriate, trials were combined using odds ratios (ORs) or weighted mean differences with 95% confidence intervals (CIs).

Results: From 746 identified references, 55 potentially relevant articles were identified and 15 articles were included. All trials were performed outside North America and were published prior to 1997. Three main treatment strategies were reviewed: strategy 1 (three articles), IV ß₂-agonists with inhaled ß₂-agonists vs inhaled ß₂-agonists; strategy 2 (six articles), IV ß₂-agonists alone vs inhaled ß₂-agonists; and strategy 3 (six articles), IV ß₂-agonists vs IV methylxanthines. Compared to all treatments, IV ß₂-agonist use did not lead to clinical or statistical significant differences in vital signs, pulmonary functions, laboratory measures, adverse effects, or clinical success. Although statistically nonsignificant, seven methodologically strong studies demonstrated that peak expiratory flows and heart rates were unchanged following ß₂-agonist use compared to all other treatments at 60 min (8.3 L/min [95% CI, 17.6 to 34.2] and 3.65 beats/min [95% CI, 2.9 to 10.2], respectively), with an increased risk of adverse effects (OR, 1.98; 95% CI, 0.5 to 8.2).

Conclusions: Evidence is lacking to support the use of IV ß₂-agonists in ED patients with severe acute asthma. Moreover, the clinical benefit appears questionable, while the potential clinical risks are obvious. The only recommendations for IV ß-₂agonist use should be in those patients in whom inhaled therapy is not feasible, or in the context of a controlled clinical trial comparing IV ß₂-agonists with standard care vs standard care alone.

Key Words: asthma • ß-agonists • emergency department • IV • pulmonary function • side effects

This article has been cited by other articles:

				POEM: Intravenous beta agonists are not indicated in severe acute asthma BMJ, March 29, 2003; 326(7391): 0 - 0. [Full Text] [PDF]

				IV {beta}2-Agonists: Not the Way to Go in the ED Journal Watch Emergency Medicine, December 30, 2002; 2002(1230): 1 - 1. [Full Text]