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Asthma - Management
Which delivery system is recommended for adults?

  • A pressurized metered-dose inhaler (pMDI) with or without a spacer is recommended for delivery of inhaled corticosteroids and bronchodilators in adults, provided that the person can use the method adequately.
  • A dry-powder inhaler (DPI) or a breath-actuated metered-dose inhaler may be more acceptable to people who are unable or unwilling to use a standard pMDI and spacer:
    • Because large-volume spacer devices are not easily portable, a DPI or a breath-actuated metered-dose inhaler (which are smaller and therefore more portable) may be appropriate for bronchodilator (reliever) use during the day or when travelling.
    • Using such a device for portable bronchodilation does not necessitate use of the same device for inhaled corticosteroid treatment or for bronchodilator treatment at home.
  • Nebulizers are rarely required for the routine management of asthma in primary care:
    • If available, a nebulizer may be used in a severe exacerbation of asthma for the combined delivery of short-acting bronchodilators and anticholinergic drugs.
Basis for recommendation
  • Good evidence from systematic reviews shows that, when used correctly, pressurized metered-dose inhalers (pMDIs) and alternative inhaler devices do not differ clinically in effectiveness [Brocklebank et al, 2001; Ram et al, 2001]. The pMDIs are generally less expensive than alternative inhaler devices.
  • Up to 70% of people cannot use a pMDI correctly. A common problem is the timing of actuation with inspiration [Giraud and Roche, 2002; Molimard et al, 2003]. Use of a spacer with a pMDI largely overcomes problems with poor technique.

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