P296 Pressure metered dose inhalers (pMDI) vs. dry power inhalers (DPI) for bronchodilation and inhibiting exercise-induced bronchoconstriction in athletes: a systematic review

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Introduction Exercise-induced bronchoconstriction (EIB) is commonly reported among athletic populations and can impair both respiratory health and athletic performance. Inhaled beta-2 agonists and glucocorticoids, delivered by pressurised Metered-Dose Inhaler (pMDI) or Dry Powder Inhaler (DPI), are widely used by athletes to manage symptoms. However, inhaler technique alongside inspiratory flow requirements may influence drug deposition and clinical effectiveness. Aim The review aims to investigate pMDI compared to DPI in eliciting bronchodilation and inhibiting bronchoconstriction in athletes. Method Studies were identified through a systematic search of MEDLINE, SPORTDiscus, and CINAHL databases via EBSCOhost. Inclusion criteria were peer-reviewed studies with placebo-controlled, randomised or crossover design. Eligible participants were classified as athletes or physically active individuals with a diagnosis with asthma, EIB, or related symptoms. Studies were required to investigate inhaled medication delivered via pMDIs, DPIs, or both. Risk of bias was assessed using Cochrane Risk of Bias tools. The review followed PRISMA reporting guidelines and registered on the PROSPERO database (registration number: CRD42024569378). Results Total of 2,767 records identified, 209 full-text articles were assessed for eligibility. Fifteen studies were eligible, but only 13 unique datasets were included in the analysis. Average sample size was 12 participants (range 6–35). Placebo groups displayed no significant bronchodilation across the included studies. Five studies investigating bronchodilator treatment administered via pMDI device, reported mean increase in FEV1 from baseline ranging from 6% to 10%. For DPI-administered bronchodilators, four studies reported a mean increase ranging from 5% to 16%. Eleven studies investigated the mean fall in FEV1 following a bronchial challenge test. Among the six studies using pMDI administration, placebo groups showed a mean fall in FEV1 ranged from -14% to -37%, whereas pMDI administered interventions reduced the mean fall in FEV1 ranging from 0% to -17%. Similarly, five DPI studies found placebo groups experienced a mean fall in FEV1 ranging from -10% to -29%, compared to DPI administered interventions attenuated the mean fall in FEV1 ranging from -3% to -7%. Conclusion Both pMDI and DPI devices demonstrated comparable bronchodilation and bronchoprotection in athletes. Results indicate that both devices are effective options for respiratory care in athletes.

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