4.1
The evidence base for pressurised metered dose inhalers (pMDIs) plus spacer versus dry-powder inhalation systems (DPI) for the delivery of corticosteroids in children with chronic asthma is relatively small and of poor quality. Two randomised controlled trials were identified, which recruited children of 5 years or under. These trials involved a total of 140 children, although the majority of these recruited children of 5 years or older. One of these trials was inadequately powered and compared a pMDI alone (not recommended by current BTS guidelines) versus DPI. The second and largest trial demonstrated no difference in steroid delivery via a pMDI plus spacer compared to DPI (at half MDI dosage).