Table 1.
Characteristics of included studies
| Study | Participants | Intervention | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Setting | Design | Sample size | Baseline FEV1 mean (SD) | Age, years mean (SD) |
Gender | Group 1 | Group 2 | Outcomes | |
| Berry [43] | USA, single centre | Double blind RXT | 20 | 0.69 ± 0.28 L | 67.9 ± 7.1 | 20M | MDI + spacer placebo 4 puffs and nebulized albuterol 2.5 mg over 10–15 min | MDI + spacer albuterol 4 puffs of 0.36 mg and nebulized placebo | FEV1 FVC Dyspnoea (Borg) Adverse events |
| Cromheecke [44] | The Nether-lands, single centre | CCT | 42 | Group 1 47.39 ± 2.94% Group 2 50.48 ± 3.75% |
Group 1 71.1 ± 1.9 Group 2 71.7 ± 1.6 |
26M 16F |
Nebulized salbutamol 10 mg | Nebulized salbutamol 5 mg | FEV1 FVC Adverse events Dyspnoea (Borg) |
| Cushen [36] | Ireland, single centre | RCT | 31 | 48 ± 18% | NR | NR | Combined salbutamol 2.5 mg/ipratropium bromide 0.5 mg via vibrating mesh nebuliser | Combined salbutamol 2.5 mg/ipratropium bromide 0.5 mg via jet nebuliser | FEV1 FVC Dyspnoea (Borg) |
| Emerman [37] | USA, single centre | RCT | 86 | Group 1 24.5 ± 11.7% Group 2 24.9 ± 11.2% |
63.9 ± 8.9 | 42M 44F |
Albuterol 2.5 mg MDI every 60 min (total 2) with saline MDI at other treatment times (total 4) | Albuterol 2.5 mg MDI every 20 min (total 6 doses) | FEV1 FVC Hospital utilisation Adverse events |
| Formgren [38] | Sweden, single centre | Double blind RXT | 15 | 35.6% (SD NR) | 61 ± 9 | 11M 4F |
Placebo turbuhaler + placebo MDI | 1) Terbutaline 1 mg via turbuhaler + placebo MDI 2) Terbutaline 1 mg via MDI + placebo turbuhaler 3) Terbutaline 2.5 mg via turbuhaler + placebo MDI with spacer 4) Terbutaline 2.5 mg via MDI with spacer + placebo turbuhaler |
FEV1 FVC |
| Moayyedi [39] | UK, single centre | RCT | 62 | Group 1 0.77 ± 0.34 L Group 2 0.78 ± .41 L |
Group 1 70.4 ± 9.1 Group 2 67.8 ± 6.7 |
NR | 5 mg nebulised salbutamol 4 times per day + standard of care | 5 mg nebulised salbutamol + 500 μg ipratropium bromide 4 times per day + standard of care | FEV1 FVC Dyspnoea (subjective) Hospital utilisation |
| Nair [40] | UK, multicentre | Double-blind RCT |
86 | 0.82 ± 0.41 L | 69.3 ± 9.3 | 39M 47F |
2.5 mg nebulized albuterol 4 hourly | 5 mg nebulized albuterol 4 hourly | FEV1 Hospital utilisation Adverse events |
| Shortall [41] | USA, multicentre | Non-blinded RCT | 34 | 0.75 L (0.5–2.02 L) | Group 1 67 Group 2 71 |
25M 9F |
40 mg oral methylprednisolone 6 hourly until asymptomatic then 40 mg daily + MDI albuterol (maximum of 20 puffs 4 hourly) and ipratropium bromide (maximum 8 puffs 4 hourly) + cefuroxime 500 mg twice daily | 40 mg IV methylprednisolone every 6 h until asymptomatic then 40 mg oral daily + 2.5 mg nebulized albuterol and 0.5 mg ipratropium bromide 4 hourly + cefuroxime 1.5 g IV 8 hourly for 36 h then 500 mg orally twice daily | FEV1 Hospital utilisation Treatment failure Dyspnoea (Borg) Adverse events |
| Willaert [42] | Belgium, single centre | RCT | 48 | Group 1 0.70 ± 0.27 L Group 2 0.82 ± 0.46 L | Group 1 71 ± 8 Group 2 72 ± 6 |
42M 6F |
32 mg oral methylprednisolone for 7 days before tapering off + 1.6 mg fenoterol and 640 μg ipratropium bromide daily via MDI + spacer | 40 mg IV methylprednisolone daily for 10 days before tapering off + 10 mg salbutamol and 1 mg ipratropium bromide aerosolised daily | FEV1 FVC Treatment failure Hospital utilisation Dyspnoea (subjective) Quality of life (CRQ) |
| Wollak [35] | USA, single centre | RCT | 15 | NR | NR | NR | 2.5 mg nebulized albuterol 4 hourly + standard of care | 5 mg/h continuous nebulized albuterol for 4 h, then 2.5 mg intermittently every 4 h + standard of care | FEV1 FVC |
Key: SD standard deviation, USA United States of America, RXT randomised crossover trial, M male, MDI metred dose inhaler, FEV1 forced expiratory volume in 1 s, FVC forced vital capacity, CCT controlled clinical trial, F female, RCT randomised controlled trial, NR not reported, UK United Kingdom, CRQ chronic respiratory questionnaire