Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis. Issue 6 (30th September 2021)

• Record Type: Journal Article
• Authors: Baggott, Christina; Hardy, Jo Katherine; Sparks, Jenny; Sabbagh, Doñah; Beasley, Richard; Weatherall, Mark; Fingleton, James
• Is Part Of: Thorax. Volume 77:Issue 6(2022)
• Page Start: 563
• Page End: 572
• Publication Date: 2021-09-30
• Subjects: asthma -- asthma guidelines -- critical care -- emergency medicine -- paediatric asthma; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2021-217124
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: International asthma guidelines recommend against epinephrine (adrenaline) administration in acute asthma unless associated with anaphylaxis or angio-oedema. However, administration of intramuscular epinephrine in addition to nebulised selective β2 -agonist is recommended for acute severe or life-threatening asthma in many prehospital guidelines. We conducted a systematic review to determine the efficacy of epinephrine in comparison to selective β2 -agonist in acute asthma. Methods: We included peer-reviewed publications of randomised controlled trials (RCTs) that enrolled children or adults in any healthcare setting and compared epinephrine by any route to selective β2 -agonist by any route for an acute asthma exacerbation. The primary outcome was treatment failure, including hospitalisation, need for intubation or death. Results: Thirty-eight of 1140 studies were included. Overall quality of evidence was low. Seventeen studies contributed data on 1299 participants to the meta-analysis. There was significant statistical heterogeneity, I 2 =56%. The pooled Peto's OR for treatment failure with epinephrine versus selective β2 -agonist was 0.99 (0.75 to 1.32), p=0.95. There was strong evidence that recruitment age group was associated with different estimates of the odds of treatment failure; with studies recruiting adults-only having lower odds of treatment failure with epinephrine. It was not possible to determine whether epinephrine in addition to selective β2 -agonist improved outcomes. Conclusion: The low-quality evidence available suggests that epinephrine and selective β2 -agonists have similar efficacy in acute asthma. There is a need for high-quality double-blind RCTs to determine whether addition of intramuscular epinephrine to inhaled or nebulised selective β2 -agonist improves outcome. PROSPERO registration number: CRD42017079472.