Review: pressurised metered dose inhalers are as effective as other hand held inhalers for delivering corticosteroids in stable asthma
QUESTION: In patients with stable asthma, is the standard chlorofluorocarbon (CFC) containing pressurised metered dose inhaler (PMDI) as effective as other hand held inhaler devices for delivering corticosteroids?
Studies published from 1966 to July 1999 were identified by searching the Cochrane Airways Group trials database and by reviewing bibliographies of relevant studies. Pharmaceutical companies that manufacture inhaled asthma drugs were contacted for further studies.
Studies in any language were selected if they were laboratory, hospital, or community based randomised controlled trials of children or adults with stable asthma that lasted ≥ 4 weeks and compared a single drug delivered by a standard PMDI (with or without a spacer device) with any other hand held inhaler. Trials comparing different doses of the same drug were also included.
2 reviewers independently extracted data on study design, patient characteristics, details of the intervention, study duration, outcomes, and quality. Outcomes included lung function, quality of life measures, symptom scores, drugs for additional relief, acuteexacerbation, days off work or school, treatment failure, patient compliance, patient preference, adverse effects, bronchial hyper-reactivity, and systemic bioavailability.
24 articles describing 29 studies met the selection criteria. 14 studies compared PMDIs with dry powder inhalers: PMDIs were less effective than dry powder inhalers for improving forced expiratory volume in 1 second, …