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Review
. 2021 Dec 1;10(23):5683.
doi: 10.3390/jcm10235683.

Matching the Inhaler to the Patient in COPD

Rudi Peché  1 , Darush Attar-Zadeh  2 , Jane Scullion  3 , Janwillem Kocks  4   5   6
Affiliations
Review

Matching the Inhaler to the Patient in COPD

Rudi Peché et al. J Clin Med. .

Abstract

Selecting the most appropriate inhalation device from the wide range available is essential for the successful management of patients with chronic obstructive pulmonary disease. Although choice is good for healthcare professionals, knowing which inhaler to prescribe is a complex consideration. Among the key factors to consider are quality of disease control, inhaler technique, inhaler resistance and inspiratory flow, inhaler design and mechanisms of drug delivery, insurance and reimbursement restrictions, and environmental impact. In this article, we offer a simple, practical tool that brings together all these factors and includes hyperlinks to other published resources from the United Kingdom, Belgium, and The Netherlands.

Keywords: device; inhaler; patient; primary care; respiratory.

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Conflict of interest statement

R.P. has nothing to disclose. D.A.-Z. reports grants, personal fees, and non-financial support from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Glenmark, Napp, Orion, Teva, Thornton & Ross, and Trudell outside the submitted work. J.S. has received support or honoraria from Chiesi, AstraZeneca, Boehringer Ingelheim, MIMS, Let’s Talk Respiratory, ADMIT, Teva, and Nursing in Practice. J.K. reports grants, personal fee, and non-financial support from AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline, grants and personal fees from Chiesi Pharmaceuticals and Teva, grants from Mundipharma, and personal fees from MSD, outside the submitted work. He holds 72.5% of shares in the General Practitioners Research Institute.

Figures

Figure 1
Figure 1
Matching the inhaler to the patient in COPD: † Take into account the influence of the pharmaceutical industry on sponsored research; ‡ Carbon footprint encompasses several elements throughout the product lifecycle, including manufacturing, propellants and plastic use/recycling. BAI, breath-actuated inhaler; DPI, dry powder inhaler; HCP, healthcare provider; ICE, ideas, concerns, and expectations; pMDI: pressurized metered-dose inhaler; SMI, soft mist inhaler. 7 Steps (https://www.respiratoryfutures.org.uk/media/69774/ukig-inhaler-standards-january-2017.pdf; accessed on 25 November 2021); Consult guidelines (https://goldcopd.org/2021-gold-reports/; accessed on 25 November 2021); Review inhaler (https://www.rightbreathe.com/; accessed on 25 November 2021); Carbon footprint (https://bmjopen.bmj.com/content/9/10/e028763; accessed on 25 November 2021); Propellants (https://bmjopenrespres.bmj.com/content/7/1/e000571; accessed on 25 November 2021); Disposable v reusable (https://link.springer.com/article/10.1007/s12325-019-01028-y; accessed on 25 November 2021); Plastics (https://erj.ersjournals.com/content/55/2/2000048; accessed on 25 November 2021); Recycling (https://bjgp.org/content/70/690/30; accessed on 25 November 2021).
Figure 2
Figure 2
Relationship between aerodynamic particle diameter and drug deposition in the upper and lower airways.
Figure 3
Figure 3
Design features, inhalation profiles, and patient considerations for the three main classes of inhalation device. * For low resistance DPIs, slow and deep inhalation is required; † Consider relevant national guidelines/best practice; ‡ The disposable device provides one month’s usage (60 actuations); the reusable device, which has replaceable cartridges, provides six months’ usage (360 actuations). DPI, dry powder inhaler; pMDI, pressurized metered-dose inhaler; SMI, soft mist inhaler. [28].
See this image and copyright information in PMC

References

    1. World Health Organization Burden of COPD. [(accessed on 12 May 2021)]. Available online: https://www.who.int/respiratory/copd/burden/en.
    1. Global Initiative for Chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2021 Report) [(accessed on 14 April 2021)]. Available online: https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25....
    1. Liew K., Wilkinson A. P280 How do we choose inhalers? patient and physician perspectives on environmental, financial and ease-of-use factors. Thorax. 2017;72:A235.
    1. Walpole S., Fitzpatric A., Moffatt K., Smith K., Potts A., Doe S., Burns G., Tedd H. P187 Ease of use, effectiveness and environmental impacts: Evaluating inhaler prescriptions, patient preferences and opportunities for improvement. Thorax. 2021;76:A190–A191.
    1. Matthys J., Elwyn G., Van Nuland M., Van Maele G., De Sutter A., De Meyere M., Deveugele M. Patients’ ideas, concerns, and expectations (ICE) in general practice: Impact on prescribing. Br. J. Gen. Pract. 2009;59:29–36. doi: 10.3399/bjgp09X394833. - DOI - PMC - PubMed

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