Optimizing drug delivery in COPD: The role of inhaler devices

Abstract

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.

Overcoming multidrug resistance through inhalable siRNA nanoparticles-decorated porous microparticles based on supercritical fluid technology

“…24 Pulmonary delivery through inhalable particulate systems, such as metered dose inhalers and dry powder inhalers, holds considerable potential in drug delivery due to its significant advantages such as superior chemical stability, uniform dosage, and no specific requirement of coordination of inhalation with activation, among others. 25,26 Despite the advantages and success in the synthesis and codelivery of anticancer drugs and siRNA by nanomedicine platform, the nanocarriers still face a significant limitation for lung cancer treatment, ie, rapid exhalation before reaching the site of action due to their small size (,0.5 µm). [27][28][29] However, the inhalation microparticles with geometric size (1-3 µm) and mass density (~1 g/cm 3 ) by various conventional manufacturing methods tend to aggregate in the dry powder inhaler leading to nonuniformity in dispensed doses and substantially prone to rapid clearance by macrophages in the lumen, which significantly reduce the efficacy of several anticancer drugs.…”

Combining long‐acting bronchodilators with different mechanisms of action: A pharmacological approach to optimize bronchodilation of equine airways

“…The currently available tiotropium bromide/olodaterol 1:1 FDC is delivered via a device that produces an inhalable soft mist characterized by small particle size, low velocity and long duration of the aerosol cloud, leading to a higher lung deposition, and lower oropharyngeal deposition compared with the pressurized metered‐dose inhalers (pMDIs) (Rogliani et al., ). By a clinical point of view these characteristics, and the once daily regimen of administration required for both monocomponents, make tiotropium bromide/olodaterol FDC a possible reliever therapy during severe exacerbations or, eventually, an add‐on therapy for severe asthmatic horses to whom oral corticosteroids cannot be administered for any reasons (i.e., laminitis risk, pregnancy, metabolic diseases).…”

Inhaler Devices for Delivery of LABA/LAMA Fixed-Dose Combinations in Patients with COPD

“…The aerosol plume generated by this device is slower and lasts longer than aerosol clouds from pMDIs [35]. Limitations of the SMI include potential issues in dose preparation, the device being non-breath-actuated, unavailability in many countries, and relatively higher costs compared with other devices [36].…”

“…In this context, the intrinsic resistance of a DPI device refers to the inspiratory flow rate required to release the correct amount of drug. Accordingly, within the DPI class, there are high (required inspiratory flow rate 90 L/min), medium (60-90 L/min), and low (\ 50 L/min) intrinsic resistance devices [30,36]. The lower the device's intrinsic resistance, the smaller the effort required from the patient to generate such airflow, which may be especially important in patients with severe airflow limitation.…”