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. 2008 Apr 16;2008(2):CD005536. doi: 10.1002/14651858.CD005536.pub2

Zar 1999.

Methods Design: Parallel group study (four arms). Randomisation: block randomisation. Blinding: single blind. Excluded: described. Withdrawals: none. Baseline characteristics: comparable. Power calculation: 22 for each spacer to ensure detection of a 15% change in PEFR at a significance level of 0.05 with a power of 90% for each type of spacer. Modified Jadad score: 3
Participants Setting: South Africa. Red Cross Children´s Hospital. 88 children (22 in each arm) aged 5 to 13 years. Inclusion criteria: children with a known history of asthma who presented to the Hospital with an acute asthma attack. Exclusion criteria: inability to use an MDI and spacer or to reliably undergo pulmonary function tests, PEFR < 20% of the predicted normal, arterial oxygen saturation < 92% in air, underlying cardiac or other chronic chronic pulmonary disease, treatment with oral corticosteroids for more than 5 days before presentation, and use of beta‐agonists within 4hours of presentation.
Interventions Beta‐agonist: fenoterol hydrobromide. Home‐made spacers: sealed 500 ml plastic cold‐drink bottle, unsealed 500 ml plastic cold‐drink bottle, and 200 ml polystyrene cup. Dosage: 4 puffs (400 µg) for children who weighed 25 kg or less, and 6 puffs (600 µg) for children who weighed more than 25 kg, given at a rate of 1 puff every 10 seconds. Co‐interventions: fenoterol 1000 µg in 2 ml normal saline via a jet nebuliser, and oxygen at a flow rate of 5 L per min in children who after bronchodilator treatment had PEFR < 70% of the predicted value. 
 Beta‐agonist: fenoterol hydrobromide. Commercial spacer: Aerochamber 145 ml. Dosage: 4 puffs (400 µg) for children who weighed 25 kg or less, and 6 puffs (600 µg) for children who weighed more than 25 kg, given at a rate of 1 puff every 10 seconds. 
 Co‐interventions: fenoterol 1000 µg in 2 ml normal saline via a jet nebuliser, and oxygen at a flow rate of 5 L per min in children who after bronchodilator treatment had PEFR < 70% of the predicted value.
Outcomes Primary outcomes: changes in clinical score and pulmonary function, and need for and response to nebulisation.
Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Method to generate randomised sequence not reported; investigators employed block randomisation.
Allocation concealment (selection bias) Unclear risk Not reported