Pressurised metered-dose inhalers (MDIs) versus dry powder inhalers devices (DPIs) to rapid-acting inhaled b2-agonists for asthma in children.
OBJECTIVE
To compare the clinical effectiveness of pressurized metered-dose inhalers (MDIs) with that of dry powder inhalers (DPIs) in delivering short-acting b2-agonists in children with asthma.


METHODS
Searches were performed in Medline (1997-March 2002), the Cochrane Library Database and the Embase reference lists of review articles and clinical trials. In addition, the international headquarters of b2-agonist manufacturers were contacted. We performed a review of randomized controlled trials.


RESULTS
Ten randomized controlled trials were included. No differences in clinical effectiveness were found between MDIs and PDIs. Two studies reported that fewer adverse events occurred when the Turbuhaler was used. Two long-term studies in children found that children preferred the MDI to the Rotohaler.


CONCLUSIONS
1) In stable asthma, short-acting b2 bronchodilators in standard MDIs are as effective as dry powder inhalers. 2) Pooling of results was limited by the small number of studies and therefore no overall conclusions could be drawn. 3) From the limited data available, we found little or no evidence for an additional clinical benefit of DPI devices over standard MDIs in children with asthma.
Negro Alvarez
J M
JM
Sección de Alergología. H.U. "Virgen de la Arrixaca". Murcia. Spain. jnegroa@meditex.es
Miralles López
J C
JC
Félix Toledo
R
R
Pagán Alemán
J A
JA
García Sellés
F J
FJ
López Sánchez
J D
JD
Hernández García
J
J
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000420:Albuterol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D006801:Humans; D036501:Metered Dose Inhalers; D009330:Nebulizers and Vaporizers; D010342:Patient Acceptance of Health Care; D011208:Powders; D016032:Randomized Controlled Trials as Topic; D018343:Receptors, Adrenergic, beta-2 / Q000187:drug effects; D013726:Terbutaline / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D011208:Powders; D018343:Receptors, Adrenergic, beta-2; D013726:Terbutaline; D000420:Albuterol