Authors' objectives:

This Effective Health Care bulletin summarises the research evidence on inhaler devices for the management of asthma and chronic obstructive pulmonary disease (COPD).

Authors' recommendations: - Asthma and chronic obstructive pulmonary disease (COPD) are common diseases of the airways and lungs that have a major impact on the health of the population. A key component of the management of these conditions involves the inhalation of medication. - There is a confusing array of inhaler devices and drug/device combinations available and it can be difficult for a clinician to make informed prescribing decisions about all the possible permutations. - Current evidence suggests that there is no difference in the effectiveness of nebulisers and alternative inhaler devices compared to standard pressurised metered-dose inhalers (pMDIs) with or without a spacer device. - As both pMDIs and dry powder inhalers are cheaper than nebulisers, a stepped approach to treatment would seem justified. pMDIs (with or without a spacer), 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 COPD. - The effectiveness of inhaler devices depends on more than just the devices themselves. Teaching patients how to use devices appropriately can be crucial. All patients should receive appropriate instruction and guidance on effective technique when prescribed inhaler devices and this should be regularly reinforced. - More expensive devices such as dry powder inhalers should be reserved for patients who are unable to use pMDIs effectively after receiving appropriate instruction.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/ehcb.htm

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination