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

Objective To determine the clinical effectiveness of pressurised metered do se inhalers (with or without spacer) compared with other hand held inhaler devices for the delivery of corticosteroids in stable asthma. Design Systematic review of randomised controlled trials. Data sources Cochrane Airways Group trials database (Medline, Embase, Cochr ane controlled clinical trials register, and hand searching of 18 relevant journals), pharmaceutical companies, and bibliographies of included trials. Trials All trials in children or adults with stable asthma that compared a pressurised metered dose inhaler with any other hand held inhaler device de livering the same inhaled corticosteroid. Results 24 randomised controlled trials were included. Significant differen ces were found for forced expiratory volume in one second, morning peak exp iratory flow rate, and use of drugs for additional relief with dry powder i nhalers. However, either these were within clinically equivalent limits or the differences were not apparent once baseline characteristics had been ta ken into account. No significant differences were found between pressurised metered dose inhalers and any other hand held inhaler device for the follo wing outcomes: lung function, symptoms, bronchial hyper-reactivity, systemi c bioavailability, and use of additional relief bronchodilators. Conclusions No evidence was found that alternative inhaler devices (dry pow der inhalers, breath actuated pressurised metered dose inhalers, or hydrofl uoroalkane pressurised metered dose inhalers) are more effective than the p ressurised metered dose inhalers for delivery of inhaled corticosteroids. P ressurised metered dose inhalers remain the most cost effective first line delivery devices.