The importance of inhaler devices in the treatment of COPD

Abstract

Chronic obstructive pulmonary disease (COPD) represents a socio-economic burden and requires regular and ongoing treatment. Inhalation therapy is recommended at all stages of the disease and allows the delivery of active molecules directly to the target site of action, whilst minimising adverse side-effects. Inhalers therefore play a crucial role in the effective management of patients with COPD and their choice is as important as that of the drug. The three most important factors that influence inhaled drug deposition within the airways are the patient's inhalation flow, the aerosol velocity, and the inhaled drug particle size. These ultimately impact on the amount of drug reaching the target site and therefore the functional and clinical responses of the patient. Furthermore, patients' training and education in the use of inhalers have been shown to be directly related to the efficacy of the therapy. However, in daily clinical practice, too little consideration is given to the features of the different inhalers and to the ability of patients to properly handle the device, and precise recommendations are greatly needed to help healthcare professionals to advise and prescribe the most 'appropriate' inhaled drug/device product. The present review aims to provide the latest evidence on the importance of the inhaler device in the management of patients with COPD.

A Network Meta-Analysis of Long-Acting Muscarinic Antagonist (LAMA) and Long-Acting β2-Agonist (LABA) Combinations in COPD

“…By contrast, the magnitude of lung function benefit using FDCs compared with placebo was often twofold higher than that seen with TIO monotherapy. The current NMA identified a potential gradient of effectiveness emerging between the once-daily FDCs and those including twice-daily LABAs, particularly with regards to improvements in trough FEV 1 It is worth noting that the effectiveness of an inhaled therapy could potentially be affected by the delivery device used [50]. While several inhaler types are available, dry powder inhalers (DPIs) have become increasingly common for COPD therapies due to their multiple advantages over the more traditional pressurized metered-dose inhalers (pMDIs) [51].…”

Inhaler device handling: have we really started to address the problem?

“…MOLIMARD et al [1] are the first to focus on inhaler technique and COPD outcomes and their study joins a handful of papers all of which confirm that poor inhaler technique is associated with poor asthma disease outcomes [2][3][4][5][6][7]. In fact, the relationship between inhaler technique and disease outcomes is further supported by complementary evidence, which shows that by improving inhaler technique improvements in disease outcome can be achieved [8][9][10][11].…”

Demystifying Inhaler Use in Chronic Obstructive Airways Disease

“…Pressurised metered-dose inhalers are compact devices that require no agent preparation and offer high dose-to-dose reproducibility. The first commercial pMDI was developed in the late 1950's by Riker Laboratories as a portable, multi-dose delivery device for bronchodilator drugs 7 . The subsequent generation of pMDIs consisted of aluminium canisters, containing a pressurised suspension of micronised drug particles dispersed in chlorofluorocarbon (CFC) propellants.…”

“…Despite progresses in the understanding of the pathophysiological mechanisms and advances in the development of new therapeutic strategies, neither asthma nor COPD can be cured, as yet. However, both diseases can be optimally controlled, and the role of inhaler devices is crucial in achieving this by personalising treatment strategies to patients 7 . Inhalation therapy is the mainstay of treatment in patients with chronic respiratory conditions, where bronchodilators (i.e.…”