How to Choose the Right Inhaler Using a Patient-Centric Approach?

Abstract

There are many different inhaler devices and medications on the market for the treatment of asthma and chronic obstructive pulmonary disease, with over 230 drug-delivery system combinations available. However, despite the abundance of effective treatment options, the achieved disease control in clinical practice often remains unsatisfactory. In this context, a key determining factor is the match or mismatch of an inhalation device with the characteristics or needs of an individual patient. Indeed, to date, no ideal device exists that fits all patients, and a personalized approach needs to be considered. Several useful choice-guiding algorithms have been developed in the recent years to improve inhaler-patient matching, but a comprehensive tool that translates the multifactorial complexity of inhalation therapy into a user-friendly algorithm is still lacking. To address this, a multidisciplinary expert panel has developed an evidence-based practical treatment tool that allows a straightforward way of choosing the right inhaler for each patient.

Patient Characteristics to Consider When Selecting an Inhaler for the Treatment of Chronic Obstructive Pulmonary Disease and Available Assessment Methods: A Narrative Review

“…Coordination between inhaler activation and inhalation is critical when using pMDIs without an inhalation chamber [5, 6, 28]. Poor coordination promotes local side effects by promoting oropharyngeal deposition and decreases efficacy by reducing the deposition of molecules in the distal airways [5].…”

“…Using a DPI requires a quick and deep inhalation to overcome the internal resistance of the inhaler [5,16], which enables the disaggregation of the active molecule from its lactose binder, creating small particles that reach the distal airways [6,[34][35][36][37]. Therefore, the needed peak inspiratory flow (PIF) varies from inhaler to inhaler, depending on their internal resistance.…”

“…These devices can be classified into five groups: (a) pressurized metered dose inhalers (pMDIs); (b) breathactuated inhalers; (c) dry powder inhalers (DPIs); (d) soft mist inhalers; and (e) nebulizers. The advantages and disadvantages of each type of inhaler have been previously described [4][5][6][7][8][9]. However, despite the availability of new inhalers, errors in their use remain a major problem and are associated with poor symptom control and more frequent exacerbations [10,11].…”

“…However, despite the availability of new inhalers, errors in their use remain a major problem and are associated with poor symptom control and more frequent exacerbations [10, 11]. Various patient, inhaler, and health system factors are associated with this misuse [5, 6]. Assessing these factors when prescribing an inhaler can help optimize the use of inhalers and achieve better disease control [12].…”

Repurposing mucosal delivery devices for live attenuated tuberculosis vaccines

“…A key component in mucosal delivery of a live TB vaccine to millions of people globally, including children, is the inhalation device. There are more than 230 inhalers available with varying mechanics that could conceptually be used to deliver TB vaccines ( Table 2 ) ( 69 , 72 ). For example, COPD and asthmatic patients are routinely prescribed specific inhalers for delivering disease-specific drugs directly into the lungs.…”