Pressurised metered dose inhalers versus all other hand-held inhaler devices to deliver beta-2 agonist bronchodilators for non-acute asthma

Cochrane Database of Systematic Reviews

Volumn , Issue 4, 2009, Pages

  Ram, Felix S F ^a   Brocklebank, David D M ^b   White, John ^c   Wright, John J ^d   Jones, Paul ^e   Lasserson, Toby J ^f  

^a MASSEY UNIVERSITY   (New Zealand)

^b ALEXANDRA HOSPITAL   (United Kingdom)

^c YORK HOSPITAL   (United Kingdom)

^d BRADFORD INSTITUTE FOR HEALTH RESEARCH   (United Kingdom)

^e ST GEORGE'S UNIVERSITY OF LONDON   (United Kingdom)

^f ST GEORGE S HOSPITAL   (United Kingdom)

Author keywords

Adrenergic beta agonists *administration dosage ; Asthma *drug therapy ; Bronchodilator agents *administration dosage ; Nebulizers and vaporizers; Pressure; Randomized controlled trials as topic

Indexed keywords

BETA 2 ADRENERGIC RECEPTOR STIMULATING AGENT; BRONCHODILATING AGENT; CHLOROFLUOROCARBON; CORTICOSTEROID; FENOTEROL; FLUORINATED HYDROCARBON; SALBUTAMOL; TERBUTALINE;

ASTHMA; COCHRANE LIBRARY; DEVICE; DRUG DELIVERY SYSTEM; DRUG EFFICACY; DRY POWDER; FORCED EXPIRATORY VOLUME; HEART RATE; HUMAN; INHALER; LUNG FUNCTION; METERED DOSE INHALER; REVIEW; SYSTEMATIC REVIEW;

EID: 77950138862     PISSN: 1469493X     EISSN: None     Source Type: Journal    
DOI: 10.1002/14651858.CD002158     Document Type: Review

References (206)

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100. Biddiscombe 1993 {published data only} Biddiscombe M, Marriot RJ, Melchor R, Short MD, Spiro SG, Taylor AJ. The preparation of pressurised metered-dose inhaler and dry powder inhalers containing Tc-labelled salbutamol. Journal of Aerosol Medicine 1991;4(Suppl 1):9.
101. Biddiscombe MF, Melchor R, Mak VHF, Marriot RJ, Taylor AJ, Short MD. The lung deposition of salbutamol, directly labelled with technetium-99m, delivered by pressurised metered dose and dry powder inhalers. Int J Pharm 1993;91:111-21.
102. Bloomfield 1979 {published data only} Bloomfield P, Cromptom GK, Winsey NJP. A tube spacer to improve inhalation of drugs from pressurised aerosols. British Medical Journal 1979;2(6203):1479.
103. Bollert 1997 {published data only} Bollert FEG, Matusiewicz SP, Dewar MH, Brown GM, McLean A, Greening AP, Crompton GK. Comparative efficacy and potency of ipratropium via turbuhaler and pressurized metered-dose inhaler in reversible airflow obstruction. European Respiratory Journal 1997; 10:1824-8. [: ISSN: 09031936]
104. Booth 1999 {published data only} Booth H. Efficiacy of new inhaler to reduce the number of drugs used in asthma management. UK, National Research Register (NRR) Serial No. N0263019470 1999.
105. Borgström 1993 {published data only} Borgström L, Newman S. Total and regional lung deposition of terbutaline sulphate inhaled via a pressurized MDI or via turbuhaler. International Journal of Pharmaceutics 1993;97:47-53.
106. Burgess 1993 {published data only} Burgess CD, Wong CS, Ayson M, Rajasingham S, Crane J. The effects of salbutamol when given by three different methods of inhalation. European Respiratory Journal. 1993; Vol. 6:593s (P1898).
107. Campbell 1995 {published data only} Campbell IA, Cloman SB, Mao JH, Prescott RJ, Weston CF. An open, prospective comparison of beta 2 agonists given via nebuliser, Nebuhaler, or pressurised inhaler by ambulance crew as emergency treatment. Thorax 1995;50(1):79-80. [MEDLINE: UI: 95192921; : PMID: 7886655]
108. Cavagni 1993 {published data only} Cavagni G, Caffarelli C, Manni PL, Stapane I, Preti PA, Cantini L. Salbutamol administered through a new spacer device to prevent exercise-induced asthma. Advances in Therapy 1993;10(5):207-16.
109. Chambers 1980 {published data only} Chambers S, Dunbar J, Tayor B. Inhaled powder compared with aerosol administration of fenoterol in asthmatic children. Archives of Diseases in Childhood 1980;55(1):73-4. [: UNI: 80196943]
110. Chhabra 1987 {published data only} Chhabra SK. Differing bioavailability of salbutamol metered-dose inhalers. Journal of Asthma 1987;24(4):215-8.
111. Chipps 1992 {published data only} Chipps BE, Naumann PF, Wong GA, Raabe OG. Clinical comparison of Gentle-haler actuator and aerochamber spacer for metered dose inhaler (MDI) use by asthmatics. Respiratory Care 1992;37(12):1414-22. [: 1993158319]
112. Cissik 1986 {published data only} Cissik JH, Bode FR, Smith JA. Double-blind crossover study of five bronchodilator medications and two delivery methods in stable asthma. Chest 1986;90(4):489-93.
113. Clark 1996 {published data only} Clark DJ, Lipworth BJ. Lung bioavailability of chlorofluorocarbon free, dry powder and chlorofluorocarbon containing formulations of salbutamol. British Journal of Clinical Pharmacology 1996;41(3): 247-9.
114. Cordero 1987 {published data only} Vazquez-cordero C, Ubetagoyena-Arrieta M, Billbao-Aburto A, Gutierrez-Mazorriaga P. Bronchodilating effect of terbutaline inhaled with and without a tube spacer in asthmatic children [Efecto broncodilatador de la terbutalina inhalada con y sin extensor en ninos asmaticos]. Anales Espanoles de Pediatria 1987;26 (6):423-6. [MEDLINE: 87324528]
115. Crimi 1989 {published data only} Crimi N, Palermo F, Cacopardo B, Vancheri C, Oliveri R, Polosa R, et. al. Effect of an aerosol delivery system on bronchodilator activity. Annals of Allergy 1989;62:26-9.
116. Cunningham 1994 {published data only} Cunningham SJ, Crain EF. Reduction of morbidity in asthmatic children given a spacer device. Chest 1994;106(3):753-7.
117. Dawson 1985 {published data only} Dawson KP, Allan J, Fergusson DM. A comparative study of the inhaled dry powders of salbutamol and fenoterol and their delivery systems. Australian Paediatric Journal 1985;21:173-4.
118. Deenstra 1988 {published data only} Deenstra M, Zanen P, Gusdorf CF. Bronchospasmolytic effects of salbutamol as powder inhalation in patients with reversible bronchial obstruction. Arztliche Forschung/Drug Research 1988;38 (10):1490-1491.
119. Donateo 1996 {published data only} Donateo L, Gerardi R, Cantini L. A new spacer device for administration of inhaled salbutamol: use in elderly asthmatics. Advances in Therapy 1996;13(5):292-300.
120. Donnell 1995 {published data only} Donnell D, Harrison LI,Ward S, et al.Acute safety of the CFC-free propellant HFA-134a from a pressurized metered dose inhaler. European Journal of Clinical Pharmacology 1995;48(6):473-7.
121. Dubus 1997 {published data only} Dubus JC, Stremler N, Mely L, Bruguerolle B. Effect of spacer device on bronchodilation in asthmatic children [Influence de la chambre d'inhalation sur la bronchodilatation chez l'enfant asthmatique]. Revue des Maladies Respiratoires 1997;14:193-8.
122. Fuglsang 1988 {published data only} Fuglsang G, Pedersen S. Cumulative dose response relationship of terbutaline delivered by three different inhalers. Allergy 1988;43: 348-52.
123. Fuller 1986 {published data only} Fuller HD. Comparison of two chamber devices in patients using a metered-dose inhaler with satisfactory technique. Canadian Medical Association Journal 1986;135:625-9.
124. Gioulekas 1996 {published data only} Gioulekas D, Papakosta D, Vordoyianni P, Baloti H, Vamvalis C. A comparison of the clinical efficacy and patient acceptability of terbutaline Turbuhaler and salbutamol Rotahaler, in adult patients with asthma. Respiratory Medicine 1996;90:205-9.
125. Glaxo Wellcome SALB3 {unpublished data only} Allen, Hanburys. Clinical efficacy and safety of the Accuhaler compared with the pressurised metered-dose inhaler (MDI) for the delivery of a single dose of
126. Gomm 1980 {published data only} Gomm SA, Keaney NP, Winsey NJP, Stretton TB. Effect of an extension tube on the bronchodilator efficacy of terbutaline delivered from a metered dose inhaler. Thorax 1980;35:552-6.
127. Green 1991 {published data only} Green CP, Price JF. Bronchodilator effect of salbutamol via the volumatic in children. Respiratory Medicine 1991;85:325-6.
128. Gunawardena 1997 {published data only} Gunawardena KA, Sohal T, Jones JI, Upchurch FC, Crompton GK. The spacehaler for delivery of salbutamol: a comparison with the standard metered-dose inhaler plus volumatic spacer device. Respiratory Medicine 1997;91:311-6.
129. Haahtela 1998 {published data only} Haahtela T, Ahone A, Hamalainen KM, Laurikainen K, Kainulainen P, Silvasti M. Histamine-induced bronchoconstriction is equally relieved by Easihaler and diskhaler salbutamol powder inhalers. Clinical Drug Investigation 1998;16(5):371-6.
130. Harrison 1996 {published data only} Harrison LI, Donnell D, Simmons JL, et al.Twenty-eight day double blind safety of an HFA-134a inhalation aerosol system in healthy subjects. Journal of Pharmacy and Pharmacology 1996;48: 596-600.
131. Harvey 1992 {published data only} Harvey J, Williams JG. Randomized cross-over comparison of five inhaler systems for bronchodilator therapy. British Journal of Clinical Practice 1992;46(4):249-51. [: UID: 93176620]
132. Haworth 1996 {published data only} Haworth J. Asthma control and morbidity: a comparison of inhaler devices. Nursing Standard 1996;11(1):31-4.
133. Herer 1993 {published data only} Herer B. Comparison of the bronchodilator effect of terbutaline inhaled from a spacer and from Turbuhaler in asthmatic adults. European Respiratory Journal. 1993; Vol. 6:593s (P1899).
134. Hidinger 1981 {published data only} Hidinger KG, Perk J. Clinical trial of a modified inhaler for pressurized aerosols. European Journal of Clinical Pharmacology 1981;20:109-11.
135. Hidinger 1984a {published data only} Hidinger KG, Kjellman NI. Childhood asthma: Improved efficacy of pressurized terbutaline aerosol by use of a 750-ml spacer. Respiration 1984;45:157-60.
136. Hidinger 1984b {published data only} Hidinger KG, Dorow P. Terbutaline from an ordinary pressurized aerosol or via a 750 ml spacer: A comparative long-term trial in two 4-week periods. Current Therapeutic Research 1984;35(3):337-41.
137. Hindle 1997 {published data only} Hindle M, Peers EM, Parry-Billings M, Chrystyn H. Relative bioavailability of salbutamol to the lung following inhalation via a novel dry powder inhaler and a standard metered dose inhaler. British Journal of Clinical Pharmacology 1997;43:336-8.
138. Huchon 2000 {published data only} Huchon G, Hofbauer P, Cannizzaro G, Iacono P, Wald F. Comparison of the safety of drug delivery via HFA- and CFCmetered dose inhalers in CAO. European Respiratory Journal 2000; 15(4):663-9. [MEDLINE: PMID: 10780756; : UI: 20241668, ISSN: 0903-1936]
139. Jenkins 1995 {published data only} Jenkins M. Clinical evaluation of CFC-free metered dose inhalers. Journal of Aerosol Medicine 1995;8(Suppl 1):S41-7.
140. Kaiser 1994 {published data only} Kaiser HB, Larsen JS, Weisberg SC, Halverson PC, Leach C. A novel breath activated (autohaler) simplifies metered dose inhaler technique while delivering a consistent dose of medication. Allergy Clinical Immunology News. 1994; Vol. 6, issue Suppl 2:382.
141. Kerac 1998 {published data only} Kerac M, Montgomery H, Johnson N. A low cost spacer device used for asthma treatment in a Calcutta street clinic to improve efficacy of metered dose inhalers. Tropical Doctor 1998;28:228-9.
142. Kishida 1993 {published data only} Kishida M, Uchiyama H, Matsumoto H, Sasamoto A, Koshibu T, Suzuki I, et al.A comparison of two delivery devices on the bronchodilatory effects of procaterol from a metered dose inhaler [Original title in Chinese]. Arerugi 1993;42(12): 1764-70. [MEDLINE: 94153163]
143. Kraemer 1985 {published data only} Kraemer R, Sennhauser F, Schoeni M. The Nebuhaler in the treatment of children with bronchial asthma: comparison of its efficacy with that of 2 other forms of administration [Der "Nebuhaler" in der Behandlung von Kindern mit Asthma bronchiale: Wirkungsvergleich mit zwei anderen Applikationsformen]. Schweizerische Rundschau fur Medizin Praxis 1985;74(18):463-6. [MEDLINE: 85244033]
144. Kunkel 2000 {published data only} Kunkel G, Magnussen H, Bergmann K, Juergens UR, de Mey C, Freund E, et al.Respimat (a new soft mist inhaler) delivering fenoterol plus ipratropium bromide provides equivalent bronchodilation at half the cumulative dose compared with a conventional metered dose inhaler in asthmatic patients. Respiration 2000;67(3):306- 14. [MEDLINE: PMID: 10867600; : UID: 20327961]
145. Lahdensuo 1986 {published data only} Lahdensuo A, Muittari A. Bronchodilator effects of a fenoterol metered dose inhaler and fenoterol powder inhaler in asthmatics with poor inhalation technique. European Journal of Respiratory Diseases 1986;68:332-5.
146. Langaker 1982 {published data only} Langaker KE, Hidinger KG. Long-term effects of a tube extension on bronchodilator treatment with pressurized aerosol. European Journal of Respiratory Diseases 1982;63:498-503.
147. Laurikainen 1997 {published data only} Laurikainen K, Silvasti M, Calderon P, Lins R, Rosillon D. Comparison of bronchodilating effects of two salbutamol dry powder inhalers in asthmatic patients. Arzneimittelforschung 1997; 47(1):44-6. [: UI: 97189172]
148. Lee 1987 {published data only} Lee H, Evans HE. Evaluation of inhalation aids of metered dose inhalers in asthmatic children. Chest 1987;91(3):366-9.
149. Liljas 1997 {published data only} Lilljas B, Stahl E, Pauwels RA. Cost-effectiveness analysis of a dry powder inhaler (Turbuhaler) versus a pressurised metered dose inhaler in patients with asthma. Pharmacoeconomics 1997;12(2 Pt 2):267-77.
150. Lindsay 1994 {published data only} Lindsay DA, Russell NL, Thompson JE, Warnock TH, Shellshear ID, Buchanan PR. A multicentre comparison of the efficacy of terbutaline turbuhaler and salbutamol pressurized metered dose inhaler in hot, humid regions. European Respiratory Journal 1994;7: 342-5.
151. Lipworth 1997 {published data only} Lipworth BJ, Clark DJ. Lung delivery of salbutamol by dry powder inhaler (Turbuhaler) and small volume anti-sattic metal spacer (Airomir CFC-free MDI plus NebuChamber). European Respiratory Journal 1997;10:1820-3.
152. Lipworth BJ, Clark DJ. Lung deposition of salbutamol given by breath activated pressurized aerosol and dry powder inhalers devices. Pulmonary Pharmacology & Therapeutics 1997;10(4): 211-4. [: UID: 98360257]
153. Lipworth 1999 {published data only} Lipworth B. Lung delivery of salbutamol with a tube spacer, oral turbuhaler and intra-nasal turbuhaler. MRC National Research Register (NRR) 1999. [: Serial no. at source N0405017509]
154. Mahadewsingh 1996 {published data only} Mahadewsingh JV, Hamersma WBGJ, Schreurs AJM. Relative efficacy of three different inhalers containing salbutamol in patients with asthma. European Journal of Clinical Pharmacology 1996;50: 469-76.
155. Malmstrom 1999 {published data only} Malmstrom K, Sorva R, Silvasti M. Application and efficacy of the multi-dose powder inhaler, Easyhaler, in children with asthma. Pediatric Allergy & Immunology 1999;10(1):66-70. [: UI: 99336701]
156. Morice 2000 {published data only} Morice AH, Stradling JR, Barnes NC. Assessment of the acceptability of a new salbutamol multidose dry powder (DPI) in patients with asthma. Clinical Drug Investigations 2000;19(3): 195-9.
157. Mortensen 1991 {published data only} Mortensen J, Groth S, Lange P, Hermansen F. Effect of terbutaline on mucociliary clearance in asthmatic and healthy subjects after inhalation from a pressurised inhaler and a dry powder inhaler. Thorax 1991;46(11):817-23. [: UID: 92124405]
158. Muittari 1979 {published data only} Muittari A, Ahonen A. Comparison of the bronchodilator effect of inhaled salbutamol powder and pressurized salbutamol aerosol. Current Therapeutic Research 1979;25:804-8.
159. Nelson 1994 {published data only} Nelson HS, Loffert T. Comparison of the bronchodilator response to albuterol administered by the Opithaler, the aerochamber, or by metered dose inhaler alone. Annals of Allergy 1994;72(4):337-40. [MEDLINE: 94205750]
160. Newman 1998 {published data only} Newman SP, Brown J, Steed KP, Reader SJ, Kladders H. Lung deposition of fenoterol and flunisolide delivered using a novel device for inhaled medicines. Comparison of Respimat with conventional metered-dose inhalers with and without spacer devices. Chest 1998;113(4):957-63.
161. Nimmo 1993 {published data only} Nimmo CJ, Chen DN, Martinusen SM, Ustad TL, Ostrow DN. Assessment of patient acceptance and inhalation technique of a pressurized aerosol inhaler and two breath-activated devices. The Annals of Pharmacotherapy 1993;27(7-8):922-7. [MEDLINE: 93372463]
162. O'Reilly 1986 {published data only} O'Reilly, Gould G, Kendrick AH, Laszlo G. Domiciliary comparison of terbutaline treatment by metered dose inhaler with and without conical spacer in severe and moderately severe chronic asthma. Thorax 1986;41:766-70.
163. Oliver 1982 {published data only} Oliver CH, Riedel F, Simpson H. Terbutaline in asthmatic children - a comparison of the conventional "inhaler" and "spacer" methods of administration. The British Journal of Clinical Practice 1982;36 (4):157-9. [MEDLINE: 83075100]
164. Pauwels 1984 {published data only} Pauwells R, Lamont H, Hidinger K, Van Der Straeten M. Influence of an extension tube on the bronchodilator efficacy of terbutaline delivered from a metered dose inhaler. Respiration 1984;45:61-6.
165. Pauwels 1996 {published data only} Pauwels RA, Hargreave FE, Camus P, Bukoski M, Stahl E. A 1-year comparison of turbuhaler vs pressurized metered-dose inhaler in asthmatic patients. Chest 1996;110(1):53-7.
166. Pedersen 1983 {published data only} Pedersen S. Aerosol treatment of bronchoconstriction in children with or without a tube spacer. The New England Journal of Medicine 1983;308:1328-30.
167. Pedersen 1985 {published data only} Pedersen S. Treatment of acute bronchoconstriction in children with use of a tube spacer aerosol and dry powder inhaler. Allergy 1985;40:300-4.
168. Rachelefsky 1986 {published data only} Rachelefsky GS, Rohr AS,Wo J, Gracey V, Spector SL, Siegel SC, et. al. Use of tube spacer to improve the efficacy of metered-dose inhaler in asthmatic children. American Journal of Diseases of the Chest 1986;140:1191-3.
169. Rivilin 1984 {published data only} Rivlin J, Mindorff C, Reilly P, Levison H. Pulmonary response to a bronchodilator delivered from three inhalation devices. Journal of Pediatrics 1984;104(3):470-3. [: UID: 84164235]
170. Rogers 1995 {published data only} Rogers DF, Ganderton D. Determinining equivalence of inhaled medications. Respiratory Medicine 1995;89:253-61.
171. Rymsa 1998 {published data only} Rymsa B, A Wolff, Schwabe S. The MAGhaler - a new form of propellant-free inhaler - how it functions and presentation of the first clinical data with the active ingredient salbutamol [Der MAGhaler - ein neuartiger treibgasfreier Inhalatortyp - Funktionsbeschreibung und erste klinische Daten mit dem Wirkstoff Salbutamol]. Atemwegs- und Lungenkrankheiten 1998, (1):S37-S41.
172. Schecker 1993 {published data only} Schecker MH, Wilson AF, Mukai DS, Hahn M, Crook D, Novey HS. A device for overcoming discoordination with metered-dose inhalers. Journal of Allergy & Clinical Immunology 1993;92(6): 783-9.
173. Selroos 1996 {published data only} Selroos O, Pietinalho A, Riska H. Delivery devices for asthma medication. Clinical implications of differences in effectiveness. Clinical Immunotherapy 1996;6:273- 99.
174. Serra 1996 {published data only} Serra JPR, Malka M, Caekert A, Marty M. Influence of inhalation device on asthmatic patients quality of life: Switch MDI to turbuhaler [Influence du dispositif d'inhalation sur la qualité de vie des patients asthmatiques: substitution des aersols doseurs habituels par le turbuhaler]. Allergie et Immunologie 1996;28(6):202-17. [: 96207206]
175. Sly 1988 {published data only} Sly RM, Barbera JM, Middleton HB, Eby DM. Delivery of albuterol aerosol by aerochamber to young children. Annals of Allergy 1988;60:403-6.
176. Stenius-Aarniala1993 {published data only} Stenius-Aarniala B, Kiviranta K, Poppius H. Evaluation of a new spacer device for drug inhalation. European Journal of Clinical Pharmacology 1993;44:153-5.
177. Terzano 1996 {published data only} Terzano C, Mannino F. Probability of particle and salbutamol deposition in the respiratory tract: comparison between MDI and Autohaler. Monaldi Archives of Chest Dieases 1996;51(3):236-42.
178. Vazquez-Aceves 1995 {published data only} Vazquez-Aceves ML, Gomez-Castillo CA, Martinez-Cairo SM, Cisneros-Gonzalez N. Effect on FEV1 induced by the administration of salbutamol with aerochamber and metered dose inhaler [Efecto en el VEF1 al administrar salbutamol con la camara de retencion, espaciador e inhalador de dosis medida]. Revista Alergia Mexico 1995;42(2):41-4. [MEDLINE: 96007080]
179. Vervloet 1994 {published data only} Vervloet D, Charpin D, Caboche MC, Vincent C, Karsenty H. Comparative trial of Maxair Autohaler versus Ventodisks in poorly coordinated asthma patients [Etude comparative de maxair autohaler versus ventodisks chez des patients asthmatiques mauvais coordinateurs]. Revue Francaise D' Allergologie Immunologie Clinique 1994;34(2):185-90. [: Embase 94228216]
180. Vidgren 1990 {published data only} Vidgren M, Paronen P, Vidgren P, Vainio P, Nuutinen J. In vivo evaluation of the new multiple dose powder inhaler and the rotahaler using the gamma scintigraphy. Acta Pharmaceutica Nordica 1990;2(1):3-10. [: UID: 90253619]
181. Vidgren 1994 {published data only} Vidgren M, Arppe J, Vidgren P, Hyvarinen L, Vainio P, Silvasti M, et al.Pulmonary deposition and clinical response of 99mTc-labelled salbutamol delivered from a novel multiple dose powder inhaler. Pharmacological Research 1994;11(9):1320-4. [: UI: 95116469]
182. Vidgren 1995b {published data only} Vidgren M, Silvasti M, Vidgren P, Sormunen H, Laurikainen K, Korhonen P. Easyhaler multiple dose powder inhaler - practical and effective alternative to the pressurized MDI. Aerosol Science and Technology 1995;22:335-45.
183. Vilsvik 1991 {published data only} Vilsvik J, Schaanning J, Stahl E, Holthe S. Comparison between bricanyl turbuhaler and ventolin metered dose inhaler in the treatment of exercise-induced asthma in adults. Annals of Allergy 1991;67(3):315-8. [MEDLINE: 91378091]
184. Waterhouse 1993 {published data only} Waterhouse JC, Sims CL, Peers EM, Morice AH. A double-blind placebo controlled comparison of inhalation from a standard metered dose inhaler and a new multi-dose dry powder inhaler. European Respiratory Journal 1993;6 (Suppl 17):593s (P1897).
185. Waterhouse 1995 {published data only} Waterhouse J, Brian P, Beran Y, Parry-billings M, Peers EM, Morice AH. A comparison of incremental doses of salbutamol delivered by a standard metered dose inhaler (MDI) or a new multidose dry powder inhaler (DPI) to healthy volunteers. Journal of Aerosol Medicine. 1995; Vol. 8:105 (P145).
186. Wong 1993 {published data only} Wong BJ, Hargreave FE. Bioequivalence of metered-dose inhaled medications. Journal of Allergy and Clinical Immunology 1993;92: 373-9.
187. Wong 1995 {published data only} Wong C, Ayson M, Rajasingham S, Burgess C, Crane J. Efficacy of a simple DIY spacer with a metered dose inhaler in asthma. New Zealand Medical Journal 1995;108:256-7.
188. Wong 1998 {published data only} Wong AG, O'Byrne PM, Lindbladh C, Inman MD, Stahl E, Hargreave E. Dose-response protective effect of salbutamol on methacholine airway responsiveness using pressurized metered dose inhalers and turbuhalers. Candian Respiratory Journal 1998;5(2): 119-23.
189. Xuan 1989 {published data only} Xuan AT, Lebeau C, Roche, Ferriere A, Chaussain M. Inhaled terbutaline administered via a spacer fully prevents exercise-induced asthma in young asthmatic subjects: a double-blind, randomised, placebo-controlled study. The Journal of International Medical Research 1989;17:506-13.
190. ATS 1993 American Thoracic Society. Guidelines for the evaluation of impairment/disability in patients with asthma. American Thoracic Society. Medical Section of the American Lung Association. American Review of Respiratory Disease 1993;147(4):1056-61. [MEDLINE: PMID: 8466106; : UI: 93221004]
191. Begg 1996 Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, et al.Improving the quality of reporting of randomized controlled trails: the CONSORT statement. Journal of the AmericanMedical Association 1996;276:637-9.
192. Boccuzzi 2000 Boccuzzi SJ, Wogen J, Roehm JB. Use of hydrofluoroalkane propellant delivery system for inhaled albuterol in patients receiving asthma medications. Clinical Therapeutics 2000;22(2): 237-47.
193. BTS 1997 British Thoracic Society. The British guidelines on asthma management. Thorax 1997;52(Suppl 1):S1-S21.
194. Chavan 1997 Chavan V, Jarvis D, Dalby R. Performance of a reformulated albuterol metered dose inhaler in the presence and absence of a spacer. Pharmaceutical Research 1997;14(11):S144.
195. Cleophas 1993 Cleophas TJ. Carry-over biases in clinical pharmacology. European Journal of Clinical Chemistry & Clinical Biochemistry 1993;31(12): 803-9.
196. Cleophas 1996 Cleophas TJ. Crossover trials are only useful when there is a positive correlation between the response to different treatment modalities. British Journal of Clinical Pharmacology 1996;41(3): 235-9.
197. Crompton 1990 Crompton GK. The adult patients difficulties with inhalers. Lung 1990;168(Suppl):658-62.
198. Egger 1997 Egger M, Davey Smith G, Schneider M, Minder C. Bias in metaanalyses detected by a simple graphical test. BMJ 1997;315: 629-34.
199. Jadad 1996 Jadad AR, Moore RA, Carrol D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al.Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Control Clinical Trials 1996; 17(1):1-12.
200. Klinger 1998 Klinger NM, Ekholm BP, Colice GL. Safety and efficacy of switching from salbutamol formulated with CFC propellant to salbutamol formulated with HFA-134a propellant in asthma care. Australian & New Zealand Journal of Medicine 1998;28(2):126.
201. Larsen 1994 Larsen JS, Hahn M, Ekholm B, Wick KA. Evaluation of conventional press-and-breathe metered-dose inhaler technique in 501 patients. Journal of Asthma 1994;31(3):193-9. [: UI: 94252971]
202. North England 1999 North of England Asthma Guideline Development Group. North of England evidence based guidelines development project: Summary version of evidence based guideline for the primary care and management of asthma in adults. British Medical Journal 1996; 312(7033):762-6.
203. van Beerendonk 1998 van Beerendonk I, Mesters I, Mudde AN, Tan TD. Assessment of the inhalation technique in outpatients with asthma or chronic obstructive pulmonary disease using a metered-dose inhaler or dry powder device. Journal of Asthma 1998;35(3):273-9. [: UI: 98326326]
204. NICE 2000 Payne N, Beard S, Brocklebank D, Ram F, Wright J, Taylor R. Effectiveness of inhaler devices for children with asthma - summary of evidence. Report commissioned by the UK National Institute for Clinical Excellence (NICE) 2000.
205. Ram 2001 Ram FSF,Wright J, Brocklebank D, White JE. Systematic review of clinical effectiveness of pressurised metered dose inhalers versus other hand held inhaler devices for delivering beta (2 )agonists bronchodilators in asthma. British Medical Journal 2001;323 (7318):901-5.
206. UK NHS R&D HTA 2001 Payne N, Beard S, Brocklebank D, Ram F, Wright J, Taylor R. Clinical and cost effectiveness of inhaler devices for children with chronic asthma. Report commissioned under the UK National Health Service Research & Development Health Technology Assessment (NHS R&D HTA) Programme 2001.