Inhalation device options for the management of chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by chronic respiratory symptoms and airflow limitation, resulting from abnormalities in the airway and/or damage to the alveoli. Primary care physicians manage the healthcare of a large proportion of patients with COPD. In addition to determining the most appropriate medication regimen, which usually includes inhaled bronchodilators with or without inhaled corticosteroids, physicians are charged with optimizing inhalation device selection to facilitate effective drug delivery and patient adherence. The large variety of inhalation devices currently available present numerous challenges for physicians that include: (1) gaining knowledge of and proficiency with operating different device classes; (2) identifying the most appropriate inhalation device for the patient; and (3) providing the necessary education and training for patients on device use. This review provides an overview of the inhalation device types currently available in the United States for delivery of COPD medications, including information on their successful operation and respective advantages and disadvantages, factors to consider in matching a device to an individual patient, the need for device training for patients and physicians, and guidance for improving treatment adherence. Finally, the review will discuss established and novel tools and technology that may aid physicians in improving education and promoting better adherence to therapy.

Formulation and Characterization of Pulmonary Drug Delivery Systems

“…Some of those errors were: "Inhaler not shaken" (40%), "Long delay before inhalation" (36%), and "Stopping inhalation as the device is fired" (32%) [24]. Thus, spacers not only reduce oropharyngeal deposition, but they also decrease the accuracy demand for the actuation and inhalation while using a pMDI on its own [25]. This is particularly advantageous in infants and children since they are unable to produce an accurate inspiratory manoeuvre or refuse to cooperate.…”

“…It is also recommended to use facemasks, especially in infants [22,23]. Moreover, the use of spacers and facemasks is also helpful and convenient for patients who require medical assistance, such as elderly patients with COPD and cognitive impairment [25,26]. It has to be noted that spacers and facemasks are likely to be exposed to contamination by microorganisms.…”

Device use errors with soft mist inhalers: A global systematic literature review and meta-analysis

“…Nebulizers produce a fine mist for medication administration for up to 20 minutes and have been used for many years in the treatment of COPD. 6,7 They do not require priming, hand-breath coordination, or breathholding and are able to aerosolize medication that the patient can inhale with regular tidal breathing. 8 There are different types of nebulizers (jet, ultrasonic, and mesh) in the market, and each varies in speed of treatment administration, ease of operation, and portability.…”

“…Important considerations include inspiratory flow sufficiency, hand-breath coordination, cognitive and mental aptitudes, and the patient's fine motor skills. 6,7,[12][13][14] In addition, patient and caregiver preferences regarding device features and costs can influence selection. 7,[15][16][17] Regardless of inhalation device types and characteristics, the patient's ability to correctly use the device is paramount to successful treatment.…”

“…[20][21][22][23][24] To this end, several systematic and narrative literature reviews, with and without a meta-analysis, have been conducted on inhaler errors specific to MDIs, DPIs, or both. 6,7,19,20,[24][25][26][27][28][29][30][31][32][33][34][35][36][37] However, similar studies on device use errors with SMIs have not been conducted. To address the existing knowledge gap, this global systematic literature review and meta-analysis was conducted to examine the prevalence and types of device use errors among adult patients with COPD who were receiving longacting bronchodilator treatment with an SMI.…”