International guidelines provide conflicting recommendations on how to use bronchodilators to manage childhood acute wheezing conditions in the emergency department (ED), and there is variation within and among countries in how these conditions are managed. This may be reflective of uncertainty about the evidence. This overview of systematic reviews (SRs) aimed to synthesize, appraise, and present all SR evidence on the efficacy and safety of inhaled short-acting bronchodilators to treat asthma and wheeze exacerbations in children 0-18 years presenting to the ED. Searching, review selection, data extraction and analysis, and quality assessments were conducted using methods recommended by The Cochrane Collaboration. Thirteen SRs containing 56 relevant trials and 5526 patients were included. Results demonstrate the efficacy of short-acting beta-agonist (SABA) delivered by metered-dose inhaler as first-line therapy for younger and older children (hospital admission decreased by 44% in younger children, and ED length of stay decreased by 33 min in older children). Short-acting anticholinergic (SAAC) should be added to SABA for older children in severe cases (hospital admission decreased by 27% and 74% when compared to SABA and SAAC alone, respectively). Continuous nebulization, addition of magnesium sulfate to SABA, and levosalbutamol compared to salbutamol cannot be recommended in routine practice.

译文

:国际准则在急诊室(ED)中如何使用支气管扩张剂来管理儿童急性喘息病提出了相互矛盾的建议,而且在这些国家和地区之间,如何管理这些情况也存在差异。这可能反映出证据的不确定性。这份系统综述(SR)概述旨在合成,评估和呈现所有有关SR吸入短效支气管扩张剂治疗0-18岁儿童哮喘和喘息加重的有效性和安全性的所有SR证据。使用The Cochrane Collaboration推荐的方法进行了搜索,评论选择,数据提取和分析以及质量评估。纳入了13项SR,包括56项相关试验和5526例患者。结果表明,定量吸入器提供的短效β受体激动剂(SABA)作为一线治疗对年幼和较大儿童的疗效(年幼儿童的医院住院减少44%,ED住院时间减少33分钟在较大的孩子中)。对于严重情况下的大龄儿童,应在SABA中添加短效抗胆碱能(SAAC)(与单独使用SABA和SAAC相比,住院率分别降低了27%和74%)。常规实践中不建议进行连续雾化,向SABA中添加硫酸镁以及与沙丁胺醇相比的左旋沙丁胺醇。

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