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.

Keywords: Asthma; COPD; Dry power inhaler; Inhaler; Patient-centric; Pressurized metered dose inhaler; Treatment algorithm.

Fig. 1

Treatment algorithm. Choosing an optimal device is guided by three core patient-centric questions. (1) Is a deep, quick voluntary inhalation possible? (2) Can sufficient inspiratory flow be obtained?, and (3) Does the patient have sufficient hand–lung coordination? Based on the answers to these questions an appropriate device can be selected. Green device option possible; Red device option not recommended; Yellow consider a device requiring low inspiratory flow; Orange only in combination with a spacer (not generally recommended). Further explanation is in the text. DPI dry powder inhaler, SMI soft mist inhaler, pMDI pressurized metered dose inhaler, BAMDI breath-actuated metered dose inhaler