Evidence of Nursing

Running head: EVIDENCE OF NURSING
Evidence of nursing
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1EVIDENCE OF NURSING
Introduction:
To find relevant research articles related to the most effective method of delivery of
bronchodilators like Salbutamol to a child with asthma, I formulated a PICO question first. The
PICO question for clinical scenario was ‘Is nebuliser a more effective method to administer or
deliver a bronchodilator compared to spacer?’. The search for article was conducted in CINAHL,
Cochrane library and PubMed by taking key search terms likes ‘nebuliser’, ‘spacer’,
‘bronchodilator delivery’, ‘bronchodilator administration’ and ‘bronchodilator delivery method’.
Other search filter that was used for retrieving articles included setting the publication date to
2013 to 2019 and selecting only journal articles in types of research. While accessing the
research articles for eligibility in relation to the PICO question, preference was given to those
evidence which had high quality research designs. For example, the as systematic review and
RCT comes under top level of evidence, studies with this research design were preferred. In
addition, other papers were taken based on consistency of outcome, research rigour and
consideration of biases.
Four best quality evidences were found by searching for articles in PubMed and
CINAHL. The first article by Cates, Welsh and Rowe (2013) retrieved from Cochrane library
‘Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma’ used
systematic review method to answer the research question and met the inclusion criteria as it
came under top level of evidence. In addition, the article by Snider et al. (2016) retrieved from
CINAHL was preferred as it used randomized trial to compare metered dose inhaler and breath
actuated inhalers. RCT research design is high quality evidence as it addressed bias and
systematic errors at different stage of research. The article by Mason et al. (2008) used
quantitative survey method of answer the research question. This article was preferred as it

2EVIDENCE OF NURSING
compared guidelines to compare performance of nebuliser and spacer. Another systematic
review retrieved from CINAHL was taken as it used systematic review method to describe acute
asthma treatment in childhood (Castro-Rodriguez, Rodrigo and Rodriguez-Martinez, 2015).
Main body:
The article by used Cates, Welsh and Rowe (2013) used systematic review method to
assess and compared delivery of beta agonist for systematic reviews by nebulizer (I) and spacer
(C) to children with acute asthma (P). The article had a clear focused question and right quality
paper was selected for the review which included RCT studies. The analysis of 39 such trials
revealed that delivery by nebulizer did not yield significantly better outcome compared to
inhalers delivered by spacers. No clear advantage was discussed regarding the advantage of
spacers to deliver bronchodilators to children with acute asthma. All the selected papers in the
study was judged for quality. However, statistically significant outcome was not found to clear
answer the research question regarding efficacy of nebulizer compared to inhalers in delivery of
nebulizers. Hence, the study findings cannot be applied in local populations as clear answer to
the research question has not been found. The study is not worth the harm and cost.
The second article Snider et al. (2016) compared metered dose inhalers (MDI) and breath
actuated nebulizers (BAN) in treating patients between 2 to 17 years with mild to moderate
asthma exacerbation. By randomly assigning patients to BAN and MDI group, it was found that
admission rate in the BAN group was 11.9% compared to 12.8% for the BAN group. The risk
difference was 0.9%. On adjustment for confounders and biases, the risk difference was found to
be 2%. The study was able to answer the research question as it revealed that MDI is effective in
treatment for asthma compared to BAN. The review of the research methodology indicated that