0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Therapeutics |

Review: Pressurized metered-dose inhalers are as effective as other handheld inhalers for ß2-agonist bronchodilator use in asthma

Amy R. Blanchard, MD; and Joseph A. Golish, MD
[+] Article and Author Information

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

For correspondence: Dr. J. Wright, Bradford Hospitals NHS Trust, Bradford, England, UK. E-mail john.wright@bradfordhospitals.nhs.uk.


Ann Intern Med. 2002;136(3):111. doi:10.7326/ACPJC-2002-136-3-111
Text Size: A A A

Question: In patients with stable asthma, is the standard chlorofluorocarbon-containing pressurized 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; hand searches 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 Web sites were also independently searched, and pharmaceutical companies that manufacture inhaled asthma drugs were contacted for unpublished studies.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 randomized controlled trials of children or adults that compared delivery of β2-agonist bronchodilators by standard PMDI (with or without a spacer) with any other handheld 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 off work or school, treatment failures, patient compliance, patient preferences, adverse effects, bronchial hyperreactivity, and systemic bioavailability.

Main results: 89 articles describing 84 studies met the selection criteria. 71 trials involved adults, and 13 involved children. In most trials, patients had mild-to-moderate asthma (baseline FEV1 > 50% of predicted). Meta-analyses were done using a fixed-effects model. In both adults and children, standard PMDIs did not differ from any of the other 10 handheld inhaler devices (Turbohaler, Diskhaler, hydrofluoroalkane PMDI, Rotahaler, Spiros, Easyhaler, multidose-powder inhaler, Clickhaler, Gentlehaler, and Autohaler) for FEV1, forced vital capacity, peak expiratory flow rate, area under the curve for FEV1, blood pressure, symptoms, bronchial hyperreactivity, systemic bioavailability, inhaled steroid requirement, serum potassium level, or use of additional relief brochodilators. However, regular use of the hydrofluoralkane PMDI containing salbutamol was associated with reduced requirement for short courses of oral corticosteroids (relative risk 0.67, 95% CI 0.49 to 0.91).

Conclusion: In patients with stable asthma, the standard chlorofluorocarbon-containing pressurized metered-dose inhaler (PMDI) is as effective as other handheld inhalers, including chlorofluorocarbon-free PMDIs, for delivering β2-agonist bronchodilators.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)