Table 1 Characteristics of included studies.

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

Publication

Country

Patient ages

pMDI arm

Comparator arma

Max. duration of treatment

Funded by device manufacturer

Overall risk of bias

Asthma – Maintenance Therapy

Amar, 201760,61

Multinational (18 countries)

5 to 11 years

MF 50 µg bd (n = 120)

MF 100 µg od (n = 125)

12 weeks

Yes

High

Barnes, 201362

Multinational (4 countries)

18 to 65 years

Extrafine BDP/FOR 200/12 µg bd (n = 215)

FP/SAL 250/50 mg bd (n = 216)

12 weeks

Yes

Unclear

Bateman, 200163

Multinational (10 countries)

12 or more years

FP/SAL 100/50 µg bd (n = 165)

FP/SAL 100/50 µg bd (n = 167)

12 weeks

Yes

Unclear

Bernstein, 201164

Multinational (Unspecified)

12 or more years

MF/FOR 200/10 µg bd (n = 371)

FP/SAL 250/50 µg bd (n = 351)

12 weeks

Yes

High

Bodzenta-Lukaszyk, 201265

Multinational (5 countries)

12 or more years

FP/FOR 250/10 µg bd (n = 140)

BUD/FOR 400/12 µg bd (n = 139)

12 weeks

Yes

Low

Bracamonte, 200566

Multinational (11 countries)

4 to 11 years

FP/SAL 100/50 µg bd (n = 215)

FP/SAL 100/50 µg bd (n = 213)

12 weeks

Yes

Low

Bronsky, 198767

USA

12 or more years

ALB 180 µg qid (n = 116)

ALB 200 µg qid (n = 115)

12 weeks

Yes

High

Busse, 2008 / O’Connor, 201068,69

USA

12 or more years

BUD/FOR 320/9 µg bd (n = 427 [Busse]; n = 368 [O’Connor])

FP/SAL 250/50 µg bd (n = 406 [Busse]; n = 350 [O’Connor])

30 weeks

Yes

High

Dusser, 200570

Multinational (8 countries)

18 to 70 years

FOR 12 µg bd (n = 225)

FOR 12 µg bd (n = 220)

12 weeks

Yes

Unclear

Kanniess, 201571

Multinational (7 countries)

18 or more years

Extrafine BDP/FOR 100/6 µg bd (n = 251)

Extrafine BDP/FOR 100/6 µg bd (n = 251)

8 weeks

Yes

Low

Kemp, 198972

USA

4 to 12 years

ALB 180 µg qid (n = 104)

ALB 200 µg qid (n = 100)

12 weeks

Unclear

Low

Koskela, 200073

Finland

pMDI mean 45 (SD 15) years; DPI mean 41 (SD 17) years

BDP 400 µg bd (n = 76)

BDP 400 µg bd (n = 68)

8 weeks

Yes

Unclear

Lundback, 199374

Multinational (10 countries)

15 to 91 years

FP 250 µg bd (n = 193)

FP 250 µg bd (n = 198)

6 weeks

Yes

Unclear

Lundback, 199475

Multinational (10 countries)

17 to 76 years

FP 100 µg bd (n = 146)

FP 100 µg bd (n = 150)

4 weeks

Yes

Unclear

Morice, 200776

Multinational (8 countries)

12 or more years

BUD/FOR 320/9 µg bd (n = 234)

BUD/FOR 320/9 µg bd (n = 229)

12 weeks

Yes

Low

Morice, 200877

Multinational (6 countries)

12 or more years

BUD/FOR 320/9 µg bd (n = 446)

BUD/FOR 320/9 µg bd (n = 227)

52 weeks

Yes

High

Nelson, 199978

USA

12 or more years

ALB 180 µg qid (n = 92)

ALB 216 µg qid (n = 97)

12 weeks

Yes

Unclear

Papi, 200779

Multinational (13 centres in Europe)

18 to 65 years

BDP/FOR 200/12 µg bd (n = 107)

BUD/FOR 400/12.0 µg bd (n = 109)

12 weeks

Yes

Unclear

Papi, 201280

Multinational (67 Respiratory Clinics in Europe)

18 to 65 years

Extrafine BDP/FOR 200/12 µg bd (n = 206)

FP/SAL 250/50 µg bd (n = 216)

24 weeks

Yes

High

Pauwels, 199681

Multinational (7 countries)

17 or more years

BDP and/or TS at previous doses (n = 506)

BUD and/or TS at doses equivalent to previous use (n = 498)

52 + /- 4 weeks

Yes

High

Poukkula, 199882

Finland

18 or more years

BDP 500 µg bd (n = 74)

BDP 500 µg bd (n = 74)

12 weeks

Yes

High

Reichel, 200183

Multinational (6 countries)

18 to 75 years

BDP 200 µg bd (n = 98)

BUD 400 µg bd (n = 95)

6 weeks

Yes

High

Srichana, 201684

Thailand

18 to 60 years

BUD 200 µg bd (n = 18)

BUD 200 µg bd (n = 18)

12 weeks

No

High

Stradling, 200085

UK

18 or more years

BDP < 2 mg/day (n = 106)

BDP < 2 mg/day (n = 98)

12 weeks

Yes

Unclear

Van Noord, 200186

Multinational (13 countries)

12 to 82 years

FP/SAL 500/50 µg bd (n = 176)

FP/SAL 500/50 µg bd (n = 161)

12 weeks

Yes

Unclear

Vincken, 200487

Multinational (3 countries)

18 to 65 years

IB/FEN 40/100 µg qid (n = 159)

IB/FEN 20/50 µg qid (SMI) (n = 161)

12 weeks

Yes

High

Von Berg, 200488

Multinational (4 countries)

6 to 15 years

IB/FEN 40/100 µg tid (n = 177)

IB/FEN 20/50 µg tid (SMI) (n = 180)

4 weeks

Yes

High

Von Berg, 200789

Multinational (8 countries)

6 to 11 years

CIC 160 µg od (n = 416)

BUD 400 µg od (n = 205)

12 weeks

Yes

Unclear

Wardlaw, 200490

–Multinational (European and Canadian sites)

12 or more years

FP 250 µg bd (n = 85)

MF 400 µg od (n = 82)

8 weeks

Yes

High

Wolfe, 200091

USA

12 or more years

SAL 42 µg bd (n = 166)

SAL 50 µg bd (n = 165)

12 weeks

Yes

Unclear

Zheng, 202392

China

18 or more years

Extrafine BDP/FOR 200/12 µg bd (n = 242)

Extrafine BDF/FOR 200/12 µg bd (n = 251)

12 weeks

Yes

Unclear

Zhou, 202593

China

18 or more years

BUD 200 µg bd (n = 78)

BUD 200 µg bd (n = 78)

4 weeks

No

Low

Asthma – Acute Exacerbation

Direkwatanachai, 201194

Thailand

5 to 18 years

Salbutamol 600 µg (n = 68)

Salbutamol 600 µg (n = 71)

60 min

Yes

High

Drblik, 200395

Canada

6 to 16 years

TS 0.5 mg/10 kg (max 2 mg) two doses 30 mins apart (n = 55)

TS 0.5 mg/10 kg (max 2 mg) two doses 30 mins apart (n = 57)

60 min

Yes

Unclear

Khaled, 201496

Bangladesh

6 to 15 years

Salbutamol 400 µg (n = 53)

Salbutamol 400 µg (n = 53)

30 min

No

High

Lodha, 200497

India

5 to 15 years

Salbutamol 400 µg (n = 78)

Salbutamol 400 µg (n = 75)

30 min

No

High

Vangveeravong, 200898

Thailand

5 to 18 years

Salbutamol 600 µg (n = 18)

Salbutamol 600 µg (n = 18)

60 min

No

High

Chronic Obstructive Pulmonary Disease (COPD)

Ferguson, 201399

USA

40 or more years

IB/salbutamol 36/206 µg qid [equivalent to 180 µg salbutamol base] (n = 154)

IB/salbutamol 20/100 µg qid (SMI) (n = 157)

48 weeks

Yes

High

Ferguson, 2018100

Multinational (7 countries)

40 to 80 years

BUD/FOR 320/10 µg bd (n = 655)

BUD/FOR 400/12 µg bd (n = 219)

24 weeks

Yes

High

Kilfeather, 2004101

Multinational (3 countries)

40 or more years

IB/FEN 40/100 qid (n = 220)

IB/FEN 20/50 qid (SMI) (n = 224)

12 weeks

Yes

High

Koser, 2010102

USA

40 or more years

FP/SAL 230/42 µg bd (n = 121)

FP/SAL 250/50 µg bd (n = 126)

12 weeks

Yes

Unclear

Maltais, 2019103

Multinational (7 countries)

40 to 95 years

Glycopyrrolate/FOR 18/9.6 µg bd (n = 552)

Umeclidinium/VI 62.5/25.0 µg od (n = 552)

24 weeks

Yes

Unclear

Wang, 2020104

China

40 to 80 years

BUD/FOR 320/9.6 µg bd (n = 72)

BUD/FOR 400/12 µg bd (n = 72)

24 weeks

Yes

High

Zuwallack, 2010105

Multinational (13 countries)

40 or more years

IB/ALB 36/206 µg qid (n = 491)

IB/ALB 20/100 µg qid (SMI) (n = 486)

12 weeks

Yes

Unclear

  1. aThe comparator is Dry Powder Inhaler (DPI) unless otherwise stated.
  2. bd: twice daily, BDP beclomethasone dipropionate, BUD budesonide, CIC Ciclesonide, DPI dry powder inhaler, FEN fenoterol hydrobromide, FF fluticasone furoate, FOR formoterol, FP fluticasone propionate, IB ipratropium bromide, MF mometasone furoate, od once daily, pMDI pressurised metered dose inhaler, qid four times daily, SAL salmeterol, SMI soft mist inhaler, tid three times daily, TS terbutaline sulphate, VI vilanterol.
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