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Systematic review of clinical effectiveness of pressurised metered dose inhalers versus other hand held inhaler devices for delivering β2agonists bronchodilators in asthma

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7318.901 (Published 20 October 2001) Cite this as: BMJ 2001;323:901
  1. Felix S F Ram, research fellow in respiratory medicinea,
  2. John Wright, consultant in clinical epidemiology and public healtha,
  3. David Brocklebank, specialist registrar in respiratory medicinea,
  4. John E S White, consultant chest physician (john.wright{at}bradfordhospitals.nhs.uk)b the National Health Technology Assessment Inhaler Review Group.
  1. a Bradford Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ
  2. b York Health Services NHS Trust, Department of Respiratory Medicine, York District Hospital, York YO3 7HE
  1. Correspondence to: J Wright
  • Accepted 11 July 2001

Abstract

Objectives: To determine the clinical effectiveness of pressurised metered dose inhalers compared with other hand held inhaler devices for delivering short acting β2 agonists in stable asthma.

Design: Systematic review of randomised controlled trials.

Data sources: Cochrane Airways Group specialised trials database (which includes hand searching of 20 relevant journals), Medline, Embase, Cochrane controlled clinical trials register, pharmaceutical companies, and bibliographies of included trials.

Trials: All trials in children or adults with stable asthma that compared the pressurised metered dose inhaler (with or without a spacer device) against any other hand held inhaler device containing the same β2 agonist.

Results: 84 randomised controlled trials were included. No differences were found between the pressurised metered dose inhaler and any other hand held inhaler device for lung function, blood pressure, symptoms, bronchial hyperreactivity, systemic bioavailability, inhaled steroid requirement, serum potassium concentration, and use of additional relief bronchodilators. In adults, pulse rate was lower in those using the pressurised metered dose inhaler compared with those using Turbohaler (standardised mean difference 0.44, 95% confidence interval 0.05 to 0.84); patients preferred the pressurised metered dose inhaler to the Rotahaler (relative risk 0.53, 95% confidence interval 0.36 to 0.78); hydrofluoroalkane pressurised metered dose inhalers reduced the requirement for rescue short course oral steroids (relative risk 0.67, 0.49 to 0.91).

Conclusions: No evidence was found to show that alternative inhaler devices are more effective than standard pressurised metered dose inhalers for delivering acting β2 agonist bronchodilators in asthma. Pressurised metered dose inhalers remain the most cost effective delivery devices.

What is already known on this topic

What is already known on this topic Many different inhaler devices are available for administration of short acting β2 agonists in asthma

Current guidelines for their use are inconsistent and not evidence based

What this study adds

What this study adds This systematic review found no evidence that alternative inhaler devices are more effective than pressurised metered dose inhalers for administering inhaled β2 agonist bronchodilators

Pressurised metered dose inhalers (or the cheapest inhaler device) should be used as first line treatment in all patients with stable asthma who require β2 agonists

Footnotes

  • Funding NHS Research and Development Health Technology Assessment Programme.

  • Competing interests None declared.

  • Accepted 11 July 2001
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