Efficacy and safety of different inhaler types for asthma and chronic obstructive pulmonary disease. a systematic review and meta-analysis.

IF 4.7 3区医学 Q1 PRIMARY HEALTH CARE

NPJ Primary Care Respiratory Medicine Pub Date : 2026-02-16 DOI:10.1038/s41533-026-00488-4

Michael J Loftus, Miranda S Cumpston, Shannon Barnes, John Blakey, Allan Glanville, Steve McDonald, Loyal Pattuwage, Megan Rees, Rachel Silk, Heath White, Tari Turner, Karin Leder

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Abstract

Pressurised metered dose inhalers (pMDIs) contain propellant gases with high global warming potential yet remain a cornerstone of management for asthma and chronic obstructive pulmonary disease (COPD). The aim of this study was to determine whether non-propellant alternatives of dry powder inhalers (DPIs) and soft mist inhalers (SMIs) had similar efficacy and safety. A systematic review was performed finding 44 randomised trials (24,710 participants) and moderate certainty evidence for most outcomes. No statistically significant or clinically important differences were found between inhaler types for any assessed measure. For asthma maintenance, the mean difference in peak expiratory flow rate between groups was 1.07 L/min (95% confidence interval [CI] -0.93 to 3.06). For COPD, the mean difference in FEV₁ between groups was 0.01 L (95% CI -0.01 to 0.02). While the choice of optimal inhaler for an individual patient is a multifaceted decision, this review provides reassurance that non-pMDI devices can perform equally well.

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不同吸入器类型对哮喘和慢性阻塞性肺疾病的疗效和安全性。系统回顾和荟萃分析。

加压计量吸入器（pmdi）含有具有高全球变暖潜势的推进剂气体，但仍然是哮喘和慢性阻塞性肺疾病（COPD）管理的基石。本研究的目的是确定干粉吸入器（dpi）和软雾吸入器（SMIs）的非推进剂替代品是否具有相似的疗效和安全性。对44项随机试验（24710名受试者）进行了系统回顾，并对大多数结果进行了中等确定性的证据。在任何评估措施中，吸入器类型之间没有发现统计学上显著或临床上重要的差异。对于哮喘维持，两组间呼气峰流速的平均差异为1.07 L/min（95%可信区间[CI] -0.93 ~ 3.06）。对于COPD，两组间FEV1平均差异为0.01 L （95% CI -0.01 ~ 0.02）。虽然为个体患者选择最佳吸入器是一个多方面的决定，但这篇综述提供了非pmdi装置同样可以表现良好的保证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

NPJ Primary Care Respiratory Medicine PRIMARY HEALTH CARE-RESPIRATORY SYSTEM

CiteScore

5.50

自引率

6.50%

发文量

审稿时长

10 weeks

期刊介绍： npj Primary Care Respiratory Medicine is an open access, online-only, multidisciplinary journal dedicated to publishing high-quality research in all areas of the primary care management of respiratory and respiratory-related allergic diseases. Papers published by the journal represent important advances of significance to specialists within the fields of primary care and respiratory medicine. We are particularly interested in receiving papers in relation to the following aspects of respiratory medicine, respiratory-related allergic diseases and tobacco control: epidemiology prevention clinical care service delivery and organisation of healthcare (including implementation science) global health.