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Review: pressurised metered dose inhalers are as effective as other hand held inhalers for β2 agonist bronchodilator 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 handheld inhaler devices, including chlorofluorocarbon free PMDIs, for delivering β2 agonist bronchodilators?

Data sources

Studies published from 1966 to December 2000 were identified by searching the Cochrane Airways Group trials database (derived from Medline, EMBASE/Excerpta Medica, CINAHL; handsearches of 20 relevant journals and proceedings of 3 respiratory societies; and review of the bibliographies of included trials). Medline, EMBASE/Excerpta Medica, CINAHL, and 17 online respiratory websites were also independently searched, and pharmaceutical companies that manufacture inhaled asthma drugs were contacted for unpublished studies.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 compared delivery of β2 agonist bronchodilators by standard PMDI (with or without a spacer) with any other hand held inhaler. Trials comparing different doses of inhaled drug 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 function (FEV1), quality of life measurements, symptom scores, drugs for additional relief, steroid requirements, nocturnal awakening, acute exacerbations, days …

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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.