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Review: pressurised metered dose inhalers are as effective as other hand held inhalers for delivering β2 agonist bronchodilators in stable asthma

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QUESTION: In patients with stable asthma, is the standard chlorofluorocarbon containing pressurised metered dose inhaler (PMDI) as effective as other hand held inhaler devices, including chlorofluorocarbon-free PMDIs, for delivering short acting β2 agonist bronchodilators?

Data sources

Studies published from 1966 to December 2000 were identified by searching the Cochrane Airways Group trials database, Medline, EMBASE/Excerpta Medica, CINAHL, and 17 online respiratory websites. Bibliographies of relevant studies were reviewed, and pharmaceutical companies that manufacture inhaled asthma drug were contacted for further studies.

Study selection

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 compared delivery of short acting β2 agonist bronchodilators by standard PMDI (with or without a spacer device) with any other hand held inhaler. Trials comparing different doses of inhaled drugs and those that used challenge testing were also included.

Data extraction

2 reviewers independently extracted data on study design, patient characteristics, details of the intervention, study duration, outcomes, and quality. Outcomes included lung …

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  • Sources of funding: NHS Research and Development Health Technology Assessment Programme.

  • For correspondence: Dr J Wright, Bradford Hospitals NHS Trust, Bradford Royal Infirmary, Bradford UK. john.wright{at}

  • A modified version of this abstract appears in ACP Journal Club.