Asthma Control: The Right Inhaler for the Right Patient

Abstract

Inhaled therapy is the cornerstone of asthma management in that it optimizes the delivery of the medication to the site of action. The effectiveness of inhaled therapy is affected by the correct choice of the device and proper inhalation technique. In fact, this influences the drug delivery and distribution along the bronchial tree, including the most peripheral airways. In this context, accumulating evidence supports the contribution of small airways in asthma, and these have become an important target of treatment. In reality, the “ideal inhaler” does not exist, and not all inhalers are the same. Advances in technology has highlighted these differences, and have led to the design of new devices and the development of formulations characterized by extrafine particles that facilitate the distribution and deposition of the drug particles along the respiratory tract. In addition, efforts have been made to implement adherence to chronic treatment, which translates into clinical benefit. Taken together, the optimal control of asthma depends on the drug that is selected, the device that is employed and the removal of factors that reduce patient’s adherence to therapy.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0201-9) contains supplementary material, which is available to authorized users.

Challenges Associated with the Pulmonary Delivery of Therapeutic Dry Powders for Preclinical Testing

“…In addition, lack of coordination between device actuation and patient inhalation (hand-breath coordination) increases the deposition in the upper airways leading to insufficient amounts of drug being delivered to the deep lungs (Scichilone, 2015). Fink and Rubin have estimated that improper inhaler maneuvers have a huge economic impact, with roughly $7-15.7 billion wasted, with no benefit to the health-care system or the patient population (Fink and Rubin, 2005).…”

“…In addition, the inspiratory flow rate must be maintained for the duration of inhalation, with deep and forceful breaths, to de-aggregate drug/lactose carrier particles and facilitate drug deposition to the deep lung (Scichilone, 2015). Moreover, a 'deep and forceful' inspiration may be difficult to achieve for patients suffering from asthma or COPD, thereby limiting the use of passive DPIs.…”

Novel inhalation devices for treatment of chronic obstructive pulmonary disease

“…Доля частиц оптимального размера практически не изме няется при различных скоростях потока в диапазоне от 40 до 100 л / мин. Средний массовый аэродинами ческий диаметр частиц, которые продуцирует Некстхалер, составляет 1,4-1,5 мкм [20].…”

Inhaler device use: Should we just forgo the detail and go for the ‘big picture’ approach?

“…It is important to recognize that, while each of these particular factors is complex, evidence suggests that we can address many of these challenges. We know a difference exists between different devices, and we can match patients to the device that is the most appropriate for them . We recognize that, for the patient, there is a range of competing factors that impact their willingness, ability and preference to using their inhalers, but we know that we can successfully train most patients to use most inhalers with effective and repeated instruction .…”