Adrenaline (epinephrine) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis

摘要: BackgroundInternational asthma guidelines recommend against adrenaline administration in acute unless associated with anaphylaxis or angioedema. However, of intra-muscular addition to nebulised selective {beta}2-agonist is recommended for severe life-threatening many pre-hospital guidelines. We conducted a systematic review determine the efficacy comparison asthma. MethodsWe included peer-reviewed publications randomised controlled trials (RCTs) that enrolled children adults any healthcare setting and compared by route an exacerbation. The primary outcome was treatment failure, as indicated hospitalisation, stay >24hrs emergency department, need intubation, death. ResultsThirty-eight 1,140 studies were included, involving 2,275 participants. Overall quality evidence low. There significant statistical heterogeneity, I2=56%. pooled odds ratio failure versus 0.99 (0.74 1.34), p=0.96. strong recruitment age-group different estimates risk failure; recruiting adults-only having lower adrenaline. It not possible whether improved outcomes. ConclusionThe limited available suggests {beta}2-agonists have similar does support use high-quality double-blind RCTs address this issue. PROSPERO registration number CRD42017079472