Metered dose inhalers most cost-effective for asthma
There is no evidence that alternative inhaler devices
are more effective than pressurised metered dose inhalers (MDIs), with
or without a spacer, for administering inhaled beta2-agonist
bronchodilators and corticosteroids, according to new reviews.
The National Health Technology Assessment Inhaler
Review Group conducted two systematic reviews to determine the clinical
effectiveness of MDIs, compared with other hand held inhaler devices,
for the delivery of short-acting beta2-agonists and corticosteroids
in stable asthma.
The group analysed 84 randomised, controlled trials
that compared devices delivering beta2-agonists and 24 that
compared devices delivering corticosteroids. For delivery of both drugs,
no significant differences were found between the MDI and any other hand
held inhaler device for the following outcome measures: lung function,
symptoms, bronchial hyperreactivity, systemic bioavailability or use of
additional relief bronchodilators. For delivery of beta2-agonists,
there was also no difference between the two groups in inhaled steroid
requirement, serum potassium concentration or blood pressure.
The authors conclude that MDIs, or the cheapest
inhaler device that the patient can use adequately, should be prescribed
as first line treatment in all patients with stable asthma (BMJ
2001;323:896 and 901).
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