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Author |
Nechelle Wall |
Date |
2020-07-26 |
|
Reviewer |
- |
Edited |
2020-10-22 |
“When providing treatment with inhaled SABAs, does the method of delivery have associated advantages or disadvantages in regard to the therapeutic effect?”
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Population |
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Intervention |
Inhaled short-acting beta2-agonists (SABAs) |
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Comparison |
Nebulizer versus Metered Dose Inhaler with spacer (MDI-S) |
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Outcome |
Clinical benefits |
Inhaled SABAs are a first-line therapeutic modality for the treatment of acute airflow limitation, secondary to progressive and reversible disease states, with characteristic decreased FEV1/FVC.
Primary objective: Increase airflow by means of bronchodilation.
SABAs bind to beta-2 adrenergic receptors which are expressed on the airways. This binding causes a cascade of signaling which ultimately results in an increase of cAMP and the subsequent activation of cAMP-dependent PKA. The sum of this signal transduction is a decrease in intracellular Ca++ levels and the activation of potassium (K+) channels, resulting in smooth muscle relaxation and bronchodilation (Hsu 2020).
Inhaled SABAs are used as a second-line therapy in the treatment of hyperkalemia induced myocardial conduction abnormalities. Characteristic changes to a diagnostic electrocardiogram include: Tall and peaked T waves, flattening of the P wave and loss of the PR interval, widening of the QRS segment, and the development of Sine waves.
Primary objective: Reduce overall serum K+ levels.
SABAs induce an intracellular shift of K+ by up-regulating the activity of Na+-K+-ATPase in the skeletal muscle (Shingarev 2010).
Pubmed: 43 Results (13 Relevant) on 2020-07-26
These papers provide evidence to support associated benefits of MDI-S delivery of SABAs in the clinical setting. The primary objective of bronchodilation remained independent of the delivery device used, with both demonstrating similar efficacy in this category (Mandelberg 1997). Whereas, no significant difference was noted in the primary objective, there was a greater association between MDI-S and other clinical advantages, respectively. MDI-S in comparison to nebulizers showed superiority in associated chronotropic effects, reduced time to amelioration of symptoms and total time of admission in hospital, they are more cost effective, and have reduced rates of pathogen transmission (Deerojanawong, 2005).
Mandelberg et al. (1999) demonstrates the utility of MDI-S delivery of SABAs in the clinical context of hyperkalemia. This double-blinded RCT compared the serum K+ levels within two control groups, group one received MDI-S Salbutamol, and group two a placebo. The serum K+ levels in group one consistently declined after an initial paradoxical rise in the first minute. Although this study does demonstrate the ability of salbutamol to decrease serum K+ independent of the mode of delivery, the study did not directly compare MDI-S vs. nebulizer. Moreover, there is a lack of research into MDI-S delivery of SABAs in the clinical context of hyperkalemia. Thus, more research needs to take place before a conclusion can be reached.