A systematic review of comparative studies of tiotropium Respimat® and tiotropium HandiHaler® in patients with chronic obstructive pulmonary disease: does inhaler choice matter?

Dahl, Ronald; Kaplan, Alan

doi:10.1186/s12890-016-0291-4

Cited by 21 publications

(17 citation statements)

References 51 publications

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“…The timing of this study in the summer of 2019 coincided with a period in which the HandiHalerÒ was predominantly used for delivery of TIO, and as such led to the use of the HandiHalerÒ as a comparator device in the current analysis. However, clinical outcomes were similar with TIO delivered using the HandiHalerÒ and the RespimatÒ (5 lg dose), suggesting that patient-dependent factors are the key consideration for selection between the two devices [30]. While there are no direct comparisons of drug delivery by SMIs, DPIs, and nebulizers, drug aerosol properties and delivery tend to be improved with nebulizers and SMIs compared with DPIs [41].…”

Section: Discussionmentioning

confidence: 87%

“…Prior comparisons of inhaler devices have been performed and showed differences between inhalers [27][28][29][30][31], but comparisons of the aerosol performance and drug deposition with nebulizers are limited. In addition, the previous analysis of the aerosol performance and drug deposition of GLY delivered using the eFlowÒ CS nebulizer assessed characteristics at constant flow or a single tidal volume, consistent with normal patients [32].…”

Section: Introductionmentioning

confidence: 99%

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In Vitro Effect of Different Airflow Rates on the Aerosol Properties of Nebulized Glycopyrrolate in the eFlow® Closed System and Tiotropium Delivered in the HandiHaler®

Ohar¹,

Bauer²,

Sharma³

et al. 2020

Pulm Ther

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Introduction: Personalized therapy for patients with COPD requires appropriate choice of drug and delivery device. Inhalers and nebulizers vary in their drug delivery characteristics, particularly the need for passive or active patient inhalation for appropriate drug dispersal and delivery. In this in vitro analysis, we assessed the aerosol performance and drug delivery of two long-acting muscarinic antagonists, glycopyrrolate (GLY; 25 lg solution; 1 ml) and tiotropium (TIO; 18 lg powder) through their respective delivery systems: the eFlowÒ Closed System (CS) vibrating membrane nebulizer and the HandiHalerÒ dry-powder inhaler (DPI). Methods: The aerosol performances of the eFlowÒ CS nebulizer and the HandiHalerÒ were determined using the Next Generation cascade Impactor. The delivered dose of GLY and TIO was determined using different breathing patterns, which varied in tidal volume and peak inspiratory flow rate, respectively, to simulate breathing conditions ranging from normal to severe obstruction. Results: Aerodynamic particle analysis showed generally similar mass median aerodynamic diameter (MMAD, range, 3.6-4.6 lm) and fine particle fraction (FPF, range, 48.2%-63.7%) with GLY delivered using the eFlowÒ CS nebulizer under all breathing patterns tested. TIO, delivered via the HandiHalerÒ, showed variations in MMAD (range, 3.8-5.8 lm) and FPF (range, 16.1%-32.4%) under different inspiratory flow rates. The majority of GLY was deposited in stages 2-5 of the impactor, which corresponds with particle sizes in the respirable range (\ 5 lm), whereas a large proportion of TIO was deposited in the throat/mouthpiece pre-separator, irrespective of test conditions. The median residual dose of GLY with eFlowÒ CS was notably lower compared to that of TIO with HandiHalerÒ (2.4%-4.4% vs. 40%-67%, respectively). Conclusions: These simulation results highlight the different deposition patterns generated by a DPI device and a vibrating membrane nebulizer, which may help inform device selection and treatment decision in COPD management.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

In Vitro Effect of Different Airflow Rates on the Aerosol Properties of Nebulized Glycopyrrolate in the eFlow® Closed System and Tiotropium Delivered in the HandiHaler®

Ohar¹,

Bauer²,

Sharma³

et al. 2020

Pulm Ther

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show abstract

“…Since device satisfaction has been associated with better outcomes, 13,14,40,42,[65][66][67] it seems prudent for clinicians to consider patient preferences during the device selection process. Indeed, GOLD treatment strategies recommend that device selection be based not only on medication availability, costs, and the prescribing physician's preferences, but also on the patient's device preferences and the ability to use the inhalation device.…”

Section: Discussionmentioning

confidence: 99%

“…Device use errors were based on the patients' ability to correctly complete the following 14 inhalation steps: 10 (1) checking the cartridge or capsule, (2) holding the inhaler in the upright position, (3) turning the base in the direction of the arrows until it clicks, (4) opening the cap, (5) not activating the inhaler inadvertently, (6) exhaling completely and away from the inhaler, (7) closing lips around the mouthpiece, (8) holding the inhaler in a horizontal position so that it is pointing to the back of throat, (9) pressing the doserelease button while taking a slow and deep inhalation, (10) continuing to inhale slowly and deeply through the mouth, (11) holding breath up to 10 seconds, (12) removing the inhaler from the mouth and breathing out, (13) repeating steps for the second puff, and (14) closing the cap. Dose preparation (priming) steps for first time device use were excluded from the analyses since only two studies 39,40 reported these types of errors.…”

Section: Respimat Smi Device Use Stepsmentioning

confidence: 99%

Device use errors with soft mist inhalers: A global systematic literature review and meta-analysis

et al. 2020

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Inhaled bronchodilators are the cornerstone of treatment for chronic obstructive pulmonary disease (COPD). Soft mist inhalers (SMIs) are devices that deliver bronchodilators. Although correct device use is paramount to successful medication delivery, patient errors are common. This global systematic literature review and meta-analysis examined device use errors with SMIs among patients with obstructive lung diseases. PubMed, EMBASE, PsycINFO, Cochrane, and Google Scholar were searched to identify studies published between 2010 and 2019 that met the following inclusion criteria: (a) English language; (b) a diagnosis of COPD, bronchitis, or emphysema; and (c) reported device use errors among adults receiving long-acting bronchodilator treatment with Respimat® SMI (i.e. Spiriva®, Stiolto®, Spiolto®, and Striverdi®). Descriptive statistics examined sociodemographics, clinical characteristics, and device use errors. Meta-analysis techniques were employed with random-effects models to generate pooled mean effect sizes and 95% confidence intervals (CIs) for overall and step-by-step errors. The I 2 statistic measured heterogeneity. Twelve studies ( n = 1288 patients) were included in this meta-analysis. Eighty-eight percent of patients had COPD, and most had moderate/very severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease spirometric stages II to IV). Aggregate results revealed that 58.9% (95% CI: 42.4–75.5; I 2 = 92.8%) of patients made ≥1 device use errors. Among 11 studies with step-by-step data, the most common errors were failure to (1) exhale completely and away from the device (47.8% (95% CI: 33.6–62.0)); (2) hold breath for up to 10 seconds (30.6% (95% CI: 17.5–43.7)); (3) take a slow, deep breath while pressing the dose release button (27.9% (95% CI: 14.5–41.2)); (4) hold the inhaler upright (22.6% (95% CI: 6.2–39.0)); and (5) turn the base toward the arrows until it clicked (17.6% (95% CI: 3.0–32.2)). Device use errors occurred in about 6 of 10 patients who used SMIs. An individualized approach to inhalation device selection and ongoing training and monitoring of device use are important in optimizing bronchodilator treatment.

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“…In qualitative research, patients indicated that non-consented inhaler switches resulted in a worse relationship with their doctor, less confidence in their medication and worse disease control perception [43]. Changing the device, but continuing the same medication at equivalent dosing, does not reduce drug efficacy [44].…”

Section: Patient Preferencesmentioning

confidence: 99%

Switching Inhalers: A Practical Approach to Keep on UR RADAR

Kaplan

Boven

2020

Pulm Ther

Self Cite

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The choice of an inhaler device is often as important as the medication put in it to achieve optimal outcomes for our patients with asthma and/or COPD. With a multitude of drug-device combinations available, optimization of respiratory treatment could well be established by switching devices rather than changing or even augmenting pharmacological or non-pharmacological therapies. Importantly, while notable between-device differences in release mechanism, particle size, drug deposition and required inspiratory flow exist, a patient uncomfortable with their device is unlikely to use it regularly and certainly will not use it properly. Switching requires a careful process and should not be done without patient consent. Switching devices entails several steps that need to be considered, which can be guided using the UR-RADAR mnemonic. It starts with (i) UncontRolled asthma/COPD (or UnaffoRdable device), followed by RADAR: (ii) review the patient's condition (e.g. diagnosis, phenotype, co-morbidities) and address reasons for suboptimal control (e.g. triggers, smoking, non-adherence, poor inhaler technique) to be ruled out before switching; (iii) assess patient's skills related to inhalation (e.g. inspiratory force); (iv) discuss inhaler switch options, patient preferences (e.g. size, daily regimen) and treatment goals; (v) allow patients input and use shared decision-making to decide final treatment choice, acknowledging individual patient skills, preferences and goals; and (vi) re-educate to the new device (at minimum, physical demonstration, verbal explanation and patient repetition, both verbally and physically) and prime the patient for the follow-up (i.e. explain the future patient journey, including multidisciplinary work flows with physicians, nurses and pharmacists).

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A systematic review of comparative studies of tiotropium Respimat® and tiotropium HandiHaler® in patients with chronic obstructive pulmonary disease: does inhaler choice matter?

Cited by 21 publications

References 51 publications

In Vitro Effect of Different Airflow Rates on the Aerosol Properties of Nebulized Glycopyrrolate in the eFlow® Closed System and Tiotropium Delivered in the HandiHaler®

In Vitro Effect of Different Airflow Rates on the Aerosol Properties of Nebulized Glycopyrrolate in the eFlow® Closed System and Tiotropium Delivered in the HandiHaler®

Device use errors with soft mist inhalers: A global systematic literature review and meta-analysis

Switching Inhalers: A Practical Approach to Keep on UR RADAR

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