The Pharmaceutical Journal
Vol 270 No 7233 p107
25 January 2003

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Effective Health Care article (more)

Standard inhalers are as good as more expensive devices and nebulisers

Current evidence suggests there is no difference in the effectiveness of nebulisers and alternative inhaler devices compared with standard pressurised metered-dose inhalers (MDIs) with or without a spacer device, according to the latest issue of Effective Health Care (2003;8:1).

The bulletin, published by the NHS Centre for Reviews and Dissemination, aims to address the "confusing array" of available inhaler devices and drug/device combinations, saying that clinicians might find it difficult to make informed prescribing decisions about possible permutations.

The report says that pressurised MDIs, or the cheapest inhaler device the patient can use adequately, should be prescribed as first-line treatment in all adults and children with stable asthma or chronic obstructive pulmonary disease. Devices can be stepped up as necessary, it suggests.

More expensive devices such as dry powder inhalers should be reserved for patients unable to use pressurised MDIs despite adequate instruction. Teaching patients how to use the devices properly is crucial, with guidance regularly reinforced, the report says.

The bulletin was based on evidence from several systematic reviews and was funded by the NHS Health Technology Assessment Programme.