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Review
. 2019 Jan-Dec:13:1753466619884532.
doi: 10.1177/1753466619884532.

What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape

Federico Lavorini  1 , Christer Janson  2 , Fulvio Braido  3 , Georgios Stratelis  2   4 , Anders Løkke  5
Affiliations
Review

What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape

Federico Lavorini et al. Ther Adv Respir Dis. 2019 Jan-Dec.

Abstract

Inhaled therapies are the cornerstone of treatment in asthma and chronic obstructive pulmonary disease, and there are a multitude of devices available. There is, however, a distinct lack of evidence-based guidance for healthcare providers on how to choose an appropriate inhaler. This review aims to summarise recent updates on topics related to inhaler choice, and to offer practical considerations for healthcare providers regarding currently marketed devices. The importance of choosing the right inhaler for the right patient is discussed, and the relative merits of dry powder inhalers, pressurised metered dose inhalers, breath-actuated pressurised metered dose inhalers, spacers and soft mist inhalers are considered. Compiling the latest studies in the devices therapy area, this review focuses on the most common types of handling errors, as well as the comparative rates of incorrect inhalation technique between devices. The impact of device-specific handling errors on inhaler performance is also discussed, and the characteristics that can impair optimal drug delivery, such as inhalation flow rate, inhalation volume and particle size, are compared between devices. The impact of patient perceptions, behaviours and problems with inhalation technique is analysed, and the need for appropriate patient education is also highlighted. The continued development of technology in inhaler design and the need to standardise study assessment, endpoints and patient populations are identified as future research needs. The reviews of this paper are available via the supplemental material section.

Keywords: COPD; asthma; critical errors; dry powder inhaler; inhalation technique; metered dose inhaler.

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Conflict of interest statement

Conflict of interest statement: Federico Lavorini has received fees for speaking and grants for research from AstraZeneca, Boehringer Ingelheim, CIPLA, Chiesi, Menarini International, Novartis, Orion and Teva, and has participated in advisory boards arranged by Boehringer Ingelheim, GlaxoSmithKline, Menarini International, Orion and Trudell.

Christer Janson has received payments for educational activities from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis and Teva, and has participated in advisory boards arranged by AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Teva.

Fulvio Braido has received fees for speaking from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Chiesi, Menarini International, Novartis, Teva, Zambon, Dompè and Lallemand, and has participated in advisory boards arranged by Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, Novartis, Mundipharma, Teva and Chiesi.

Georgios Stratelis is a full-time employee of AstraZeneca.

Anders Løkke has received fees for lectures and for educational activities from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis, GlaxoSmithKline, Mundipharma and Novartis, and has participated in advisory boards arranged by AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Pfizer and Novartis. Furthermore, he has received grants for research from Pfizer, Boehringer Ingelheim and Novartis, as well as research-related travel accommodation from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis, GlaxoSmithKline, Mundipharma, Orion and Novartis. Anders Løkke has previously been/is currently a principal investigator in pharmaceutical company-sponsored research studies for AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Novartis.

Figures

Figure 1.
Figure 1.
Turbuhaler®, Easyhaler® and Spiromax® budesonide delivered dose ratios with various inhalation volumes compared with 4 l for the budesonide/formoterol 160/4.5 and 320/9 µg delivered dose strengths.
Figure 2.
Figure 2.
Mean delivered budesonide dose for (a) Turbuhaler®, (b) Easyhaler® and (c) Spiromax® when the device was shaken and not shaken. For each combination device of budesonide/formoterol, the expected delivered dose of budesonide was 320 µg.
See this image and copyright information in PMC

References

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