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Review: pressurised metered dose inhalers are as effective as other hand held inhalers for corticosteroid use in 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 for delivering corticosteroids?

Data sources

Studies published from 1966 to July 1999 were identified by searching the Cochrane Airways Group trials database (derived from Medline, EMBASE/Excerpta Medica, CINAHL; hand searches of 18 relevant journals and proceedings of 3 respiratory societies; and reviews of bibliographies of relevant studies). Pharmaceutical companies that manufacture inhaled asthma drugs were contacted for unpublished studies.

Study selection

Studies in any language were selected if they were laboratory, hospital, or community based randomised controlled trials of children or adults that lasted ≥ 4 weeks and compared a single drug delivered by a standard PMDI (with or without a spacer) with any other hand held inhaler. Trials comparing different doses of the same drug 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 function (FEV1), quality of life measurements, symptom scores, drugs for additional relief, acute exacerbation, days off work or school, treatment failure, patient compliance, patient preference, adverse effects, bronchial hyperreactivity, and systemic bioavailability.

Main results

24 articles describing 29 studies met the selection …

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

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

  • A modified version of this abstract also appears in Evidence-Based Nursing.