Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. A meta-analysis of randomized trials

Am J Emerg Med. 2006 Mar;24(2):217-22. doi: 10.1016/j.ajem.2005.10.008.


Objective: To evaluate the efficacy of aerosolized adrenaline compared to inhaled beta(2) agonists in the treatment of acute asthma in the emergency setting.

Data sources: MEDLINE, EMBASE, CINAHI, and Cochrane databases, review articles, and references of included trials.

Review methods: Published (1966-2005) randomized controlled trials with pulmonary function as primary outcome.

Results: Six studies met the criteria for inclusion in the meta-analysis. They included 161 adults and 121 children and adolescents. Patients who received inhaled adrenaline showed a nonsignificant improvement in pulmonary function (standardized mean difference = 0.20, 95% confidence interval -0.22 to 0.63, P = .35) compared to patients getting inhaled beta(2) agonists. Moderate heterogeneity was identified between studies (I(2) = 47.2%). Homogeneity was achieved when studies that reported pulmonary function were stratified by intensity of adrenaline treatment. The use of more than 2 mg of adrenaline per dose was equivalent to 5 mg of salbutamol or terbutaline per dose. On the contrary, 2 mg or less of adrenaline per dose was inferior to 2.5 or 5 mg of salbutamol per dose. In addition, there were no differences in heart rate and Pao(2) between treatments.

Conclusions: There was no statistically significant benefit of nebulized adrenaline over salbutamol or terbutaline in the treatment of children and adults with moderate-severe acute asthma.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Acute Disease
  • Administration, Inhalation
  • Adolescent
  • Adrenergic beta-Agonists / administration & dosage*
  • Adult
  • Aerosols
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Child
  • Emergency Treatment
  • Epinephrine / administration & dosage*
  • Humans
  • Randomized Controlled Trials as Topic
  • Respiratory Function Tests


  • Adrenergic beta-Agonists
  • Aerosols
  • Epinephrine