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Inhaled medication is the cornerstone of the pharmacological treatment for patients with asthma and chronic obstructive pulmonary disease (COPD). Several inhaler devices exist, and each device has specific characteristics to achieve the optimal inhalation of drugs. The correct use of inhaler devices is not granted and patients may incur in mistakes when using pressurized metered-dose inhalers (pMDIs) or dry-powder inhaler (DPIs). The incorrect use of inhaler devices can lead to a poorly controlled disease status. Unfortunately, guidelines provide limited guidance regarding the choice of devices. This article presents a review of the literature on different inhaler device requirements. Data from literature (PubMed and Google Scholar) on the commercially available inhaler devices have been evaluated and the history of inhaler medicine described. Furthermore, advantages and disadvantages of each type of device have been analyzed. The evaluation of literature indicated the availability of robust data on the devices characteristics and factors influencing selection of delivery devices. Each type of device has its own pro and cons. The age, cognitive status, visual acuity, manual dexterity, manual strength and ability to coordinate the inhaler actuation with inhalation may be as important as the disease severity in determining the correct approach to delivery of respiratory medication. The administration of effective therapies via a device that is simple to use and accepted by patients may help to improve treatment outcomes in patients with COPD.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent responsible for the recent coronavirus disease 2019 (COVID-19) pandemic. The virus is predominantly spread through large droplets. The clinical features of COVID-19 are varied, ranging from asymptomatic to acute respiratory distress syndrome and multi-organ dysfunction [1].The diagnosis of COVID-19 is mainly based on typical symptoms, history of exposure to an infected person and bilateral involvement on chest radiographs; it is confirmed by a positive nucleic acid test for SARS-CoV-2 from numerous types of specimens, including oropharyngeal (OP) and nasopharyngeal (NP) swabs, anal swabs, stool, urine and bronchoalveolar lavage fluid (BALF) [1, 2]. Reverse transcriptase (RT)-PCR that targets the RdRP, N or E genes is the most common method of SARS-CoV-2 detection [3]. OP and NP swabs are the most frequently used samples, but it has been demonstrated that their sensitivity is limited, at 32% and 63% respectively, while BALF is reported to be positive in 93% of patients [4]. However, the role of bronchoscopy in ruling out suspected COVID-19 patients is under debate. According to several guidelines, bronchoscopy is relatively contraindicated, mainly because of its high risk of spreading the infection to the staff involved in the procedure [5,6]. It is primarily recommended in immunocompromised patients, if there is the strong suspicion of superinfection or mucus plugging, or in life-saving conditions, and it is not strictly recommended in the COVID-19 diagnostic algorithm. Nevertheless, some cases of negative OP and NP swabs, in which BALF tested positive for SARS-CoV-2 with RT-PCR, have been reported [7,8].

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This meta-analysis clearly demonstrates that if the goal of the therapy is to enhance exercise capacity in patients with COPD, LABA/LAMA combinations consistently meet the putative clinically meaningful differences for both ET and IC and, in this respect, are superior to their monocomponents.