Considerations for Optimal Inhaler Device Selection in Chronic Obstructive Pulmonary Disease

Dhand, Rajiv; Cavanaugh, Tricia; Skolnik, Neil

doi:10.3949/ccjm.85.s1.04

Cited by 15 publications

(29 citation statements)

References 56 publications

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“…(3) The responses were many fold: replacement of pMDI propellants, development of more efficient nebulizers, development of soft mist inhalers (SMIs), and the development of numerous novel dry powder inhalers (DPIs). (4,5) Despite this huge effort, only one SMI has made it to the market, (6) the utility of nebulizers remains in pediatric and elderly patients who have problems using other forms of inhalers, (7,8) and the popularity of pMDIs remains unabated. (9) While DPIs are more valuable in total sales value, the pMDI outweighs the DPI in total number of doses sold by a factor of four (Table 1).…”

Section: Introductionmentioning

confidence: 99%

The Confusing World of Dry Powder Inhalers: It Is All About Inspiratory Pressures, Not Inspiratory Flow Rates

Clark¹,

Weers²,

Dhand

2020

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Dry powder inhalers (DPIs) all have the ability to aerosolize dry powders, but they each offer different operating mechanisms and resistances to inhaled airflow. This variety has resulted in both clinician and patient confusion concerning DPI performance, use, and effectiveness. Particularly, there is a growing misconception that a single peak inspiratory flow rate (PIFR) can determine a patient's ability to use a DPI effectively, regardless of its design or airflow resistance. For this review article, we have sifted through the relevant literature concerning DPIs, inspiratory pressures, and inspiratory flow rates to provide a comprehensive and concise discussion and recommendations for DPI use. We ultimately clarify that the controlling parameter for DPI performance is not the PIFR but the negative pressure generated by the patient's inspiratory effort. A pressure drop * ‡1 kPa (*10 cm H 2 O) with any DPI is a reasonable threshold above which a patient should receive an adequate lung dose. Overall, we explore the underlying factors controlling inspiratory pressures, flow rates and dispensing, and dispersion characteristics of the various DPIs to clarify that inspiratory pressures, not flow rates, limit and control a patient's ability to generate sufficient flow for effective DPI use.

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Section: Introductionmentioning

confidence: 99%

The Confusing World of Dry Powder Inhalers: It Is All About Inspiratory Pressures, Not Inspiratory Flow Rates

Clark¹,

Weers²,

Dhand

2020

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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“…Understanding the pro and cons helps clinicians in choosing the proper device for the individual patient's clinical needs and preferences. However, inhaler selection remains challenging [12].…”

Section: Introductionmentioning

confidence: 99%

Inhaler devices in asthma and COPD patients – a prospective cross-sectional study on inhaler preferences and error rates

2020

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Background: Inhalation therapy is the backbone of asthma and COPD control. However, inhaler adherence and device mishandling continue to be a problem in real life. Some studies have shown that using a patient-preferred inhaler may reduce device handling errors and improve adherence to prescribed chronic inhaler drug therapy. The aim of this study was to compare the preferences for commonly used inhaler devices in Germany in patients with chronic obstructive respiratory disease. We also pursued the question which properties of an inhaler device are particularly important to the user and what effects age, gender and type of disease (asthma or COPD) may have on device preference and handling errors. Methods: Prospective, open-label cross-sectional study in which 105 patients with asthma (58%) or COPD (42%) participated. Validated checklists were used to objectively assess inhaler technique and errors with 10 different placebo devices. For each device, patients were asked to test the handling, to assess the device properties and to name the device that they would most or least prefer. Results: Across the 10 placebo inhaler devices tested, patients needed an average of 1.22 attempts to error-free use. The device with the lowest mean number of attempts was the Turbohaler® (1.02), followed by the Nexthaler® (1.04), the Diskus® (1.07) and the Spiromax® (1.10). Patients over 60 years vs. younger age (p = 0.002) and COPD vs. asthma patients (p = 0.016) required more attempts to ensure correct use. 41% of the study participants chose one of the devices they already used as the most preferred inhaler. Overall, 20% opted for the Spiromax®, 15% for the Nexthaler® and 14% for the Turbohaler® or a pMDI. The least preferred device was the Elpenhaler® (0%). From a selection of 7 predefined inhaler attributes, patients stated easy handling as the most important for them. This was followed by short inhalation time and low inhalation resistance. Conclusions: Patient preference may vary between inhaler devices. The lowest number of attempts to error-free use was reported for the Turbohaler® and the Nexthaler®. The Spiromax® and the Nexthaler® achieved the best overall ratings and were the devices most preferred by patients.

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“…The algorithm for choosing an inhaler depends on the patient's state of consciousness, inspiration flow, and ability to coordinate inhaler actuation during inspiration . There are several recent reviews that address inhaler selection, administration, educational aspects, adherence, and critical errors …”

Section: Inhaler Devicesmentioning

confidence: 99%

“…Nonetheless, patients with COPD find inhalers difficult to use, which may negatively affect treatment adherence. Both patients and physicians ranked “easy and simple instructions” as the most important characteristic of an inhaler . As a significant portion of the COPD population is elderly, durable devices requiring low dexterity is encouraged for phase III studies.…”

Section: Inhaler Devicesmentioning

confidence: 99%

Review of Drug Development Guidance to Treat Chronic Obstructive Pulmonary Disease: US and EU Perspectives

Haarst

McGarvey

Paglialunga

2019

Clin Pharma and Therapeutics

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Chronic obstructive pulmonary disease (COPD) remains a leading cause of death worldwide, yet only one new drug class has been approved in the last decade. However, resurgence in COPD treatment has been recently fueled by a greater understanding of the pathophysiology and natural history of the disease, as well as a growing prevalence and an aging population. Currently, there are nearly 25 novel drug targets in development. Furthermore, the indication has undergone some fundamental changes over the last couple of years, including an updated diagnosis paradigm, validation, and approval of patient-reported outcome questionnaires for clinical trials, and drug development tools, such as a prognostic biomarker for patient selection. In the context of clinical trials, this review aims to summarize recent changes to the diagnosis and evaluation of COPD and to provide an overview of US and European regulatory guidance. CHRONIC OBSTRUCTIVE PULMONARY DISEASE LANDSCAPE

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Considerations for Optimal Inhaler Device Selection in Chronic Obstructive Pulmonary Disease

Cited by 15 publications

References 56 publications

The Confusing World of Dry Powder Inhalers: It Is All About Inspiratory Pressures, Not Inspiratory Flow Rates

The Confusing World of Dry Powder Inhalers: It Is All About Inspiratory Pressures, Not Inspiratory Flow Rates

Inhaler devices in asthma and COPD patients – a prospective cross-sectional study on inhaler preferences and error rates

Review of Drug Development Guidance to Treat Chronic Obstructive Pulmonary Disease: US and EU Perspectives

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