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Thorax Jul 2003Despite the lack of reversibility, patients with chronic obstructive pulmonary disease (COPD) often report symptomatic improvement with inhaled short acting beta(2)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Despite the lack of reversibility, patients with chronic obstructive pulmonary disease (COPD) often report symptomatic improvement with inhaled short acting beta(2) agonist bronchodilators (ISABAs) in the management of both stable and acute exacerbations of COPD. A review of the literature was undertaken to determine the effectiveness of regular treatment with ISABAs compared with placebo in stable COPD.
METHODS
A search for randomised controlled trials was carried out using the Cochrane Collaboration database of trials up to and including May 2002.
RESULTS
Thirteen studies of 7 days to 8 weeks in duration on 237 patients aged 56-70 years with forced expiratory volume in 1 second (FEV(1)) 60-70% predicted were included in the review. All studies used a crossover design with adequate washout periods and were of high methodological quality. ISABA was delivered either through a nebuliser or a pressurised metered dose inhaler. Spirometric tests performed at the end of the study and after the treatment (post-bronchodilator) showed a slight but significant increase in FEV(1) and forced vital capacity (FVC) compared with placebo. In addition, both morning and evening peak expiratory flow rate (PEFR) were significantly better during active treatment than during placebo. An improvement in the daily breathlessness score was observed with ISABA treatment. The risk of treatment failure was reduced by more than 50% with ISABA. Preference for ISABA was nine times higher than for placebo.
CONCLUSIONS
Use of ISABA on a regular basis for at least 7 days in patients with stable COPD is associated with improvements in post-bronchodilator lung function and decreases in both breathlessness and treatment failure. This review has shown that regular administration of ISABAs is an effective and inexpensive treatment for the management of patients with stable COPD.
Topics: Administration, Inhalation; Adrenergic beta-Agonists; Dyspnea; Forced Expiratory Volume; Humans; Patient Satisfaction; Peak Expiratory Flow Rate; Practice Guidelines as Topic; Pulmonary Disease, Chronic Obstructive; Randomized Controlled Trials as Topic; Treatment Failure; Vital Capacity
PubMed: 12832670
DOI: 10.1136/thorax.58.7.580 -
BMJ (Clinical Research Ed.) Oct 2001To determine the clinical effectiveness of pressurised metered dose inhalers compared with other hand held inhaler devices for delivering short acting beta(2) agonists... (Comparative Study)
Comparative Study Meta-Analysis
Systematic review of clinical effectiveness of pressurised metered dose inhalers versus other hand held inhaler devices for delivering beta (2 )agonists bronchodilators in asthma.
OBJECTIVES
To determine the clinical effectiveness of pressurised metered dose inhalers compared with other hand held inhaler devices for delivering short acting beta(2) agonists in stable asthma.
DESIGN
Systematic review of randomised controlled trials.
DATA SOURCES
Cochrane Airways Group specialised trials database (which includes hand searching of 20 relevant journals), Medline, Embase, Cochrane controlled clinical trials register, pharmaceutical companies, and bibliographies of included trials.
TRIALS
All trials in children or adults with stable asthma that compared the pressurised metered dose inhaler (with or without a spacer device) against any other hand held inhaler device containing the same beta(2) agonist.
RESULTS
84 randomised controlled trials were included. No differences were found between the pressurised metered dose inhaler and any other hand held inhaler device for lung function, blood pressure, symptoms, bronchial hyperreactivity, systemic bioavailability, inhaled steroid requirement, serum potassium concentration, and use of additional relief bronchodilators. In adults, pulse rate was lower in those using the pressurised metered dose inhaler compared with those using Turbohaler (standardised mean difference 0.44, 95% confidence interval 0.05 to 0.84); patients preferred the pressurised metered dose inhaler to the Rotahaler (relative risk 0.53, 95% confidence interval 0.36 to 0.78); hydrofluoroalkane pressurised metered dose inhalers reduced the requirement for rescue short course oral steroids (relative risk 0.67, 0.49 to 0.91).
CONCLUSIONS
No evidence was found to show that alternative inhaler devices are more effective than standard pressurised metered dose inhalers for delivering acting beta(2 )agonist bronchodilators in asthma. Pressurised metered dose inhalers remain the most cost effective delivery devices.
Topics: Adrenergic beta-Agonists; Adult; Asthma; Bronchodilator Agents; Child; Drug Administration Schedule; Humans; Nebulizers and Vaporizers; Patient Satisfaction; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 11668134
DOI: 10.1136/bmj.323.7318.901 -
BMJ (Clinical Research Ed.) Oct 2001To determine the clinical effectiveness of pressurised metered dose inhalers (with or without spacer) compared with other hand held inhaler devices for the delivery of... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To determine the clinical effectiveness of pressurised metered dose 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, Cochrane 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 delivering the same inhaled corticosteroid.
RESULTS
24 randomised controlled trials were included. Significant differences were found for forced expiratory volume in one second, morning peak expiratory flow rate, and use of drugs for additional relief with dry powder inhalers. However, either these were within clinically equivalent limits or the differences were not apparent once baseline characteristics had been taken into account. No significant differences were found between pressurised metered dose inhalers and any other hand held inhaler device for the following outcomes: lung function, symptoms, bronchial hyper-reactivity, systemic bioavailability, and use of additional relief bronchodilators.
CONCLUSIONS
No evidence was found that alternative inhaler devices (dry powder inhalers, breath actuated pressurised metered dose inhalers, or hydrofluoroalkane pressurised metered dose inhalers) are more effective than the pressurised metered dose inhalers for delivery of inhaled corticosteroids. Pressurised metered dose inhalers remain the most cost effective first line delivery devices.
Topics: Adult; Androstadienes; Asthma; Beclomethasone; Candidiasis, Oral; Child; Fluticasone; Glucocorticoids; Hoarseness; Humans; Hydrocortisone; Nebulizers and Vaporizers; Peak Expiratory Flow Rate; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 11668133
DOI: 10.1136/bmj.323.7318.896