Improving the Efficiency of Respiratory Drug Delivery: A Review of Current Treatment Trends and Future Strategies for Asthma and Chronic Obstructive Pulmonary Disease

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous airway diseases associated with significant morbidity and mortality. Pharmacological treatment is delivered primarily through the inhalation route using various devices. Optimal disease control is highly dependent upon patient adherence. Both patients with asthma and COPD are prone to exacerbations leading to hospitalization, which can significantly impact quality of life. Poor adherence is a complex and multifactorial problem that does not have one simple solution. However, it is the biggest risk factor for exacerbations and consequently high healthcare utilization. This review discusses the complex and multifactorial obstacles that impact patient adherence as well as the effect on overall treatment outcomes and healthcare utilization. We also critically examined and compared relatively recent improvements in breath-activated pressurized metered dose inhalers, dry powder inhalers, and e-technology in asthma and COPD. Finally, future treatment strategies for better patient compliance such as personalized medicine and the importance of decision-making between patients and physicians were highlighted.

Keywords: Adherence; Asthma; Chronic obstructive pulmonary disease (COPD); Future treatments; Inhaler development.

Fig. 1

Stepwise approach to treatment of asthma. SABA short-acting β₂-agonist, ICS inhaled corticosteroid, LTRA leukotriene receptor antagonist, LABA inhaled long-acting β₂-agonist, LAMA short-acting antimuscarinic antagonist

Fig. 2

SABA short-acting β₂-agonist, SAMA short-acting antimuscarinic antagonist, LABA long-acting β₂-agonist, LAMA short acting antimuscarinic antagonist, ICS inhaled corticosteroid