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Background: Bronchodilators are a central component of the treatment of COPD exacerbations all over the world. Nebulizers are frequently used, especially in the acute setting, and many patients claim and seem to benefit from them. However evidence is sparse to support the choice for nebulisers versus pressurized metered dose inhalers (pMDI).

Objectives: To investigate whether there are significant differences in efficacy and safety between nebulisers compared to pMDI currently used for bronchodilator therapy for exacerbations of COPD.

Selection criteria: Randomised controlled trials (RCTs) during COPD exacerbations were included. RCTs during a mechanical ventilation setting were excluded.

Main results: For the primary endpoints “change in FEV₁” and “severe adverse events” no significant difference were found. For the endpoint “change in FEV₁” we found a difference of 62 ml based on 4 trials (P=0.07 95 …