Volume 19 Issue 1 March 2010Review
The ADMIT series – Issues in Inhalation Therapy.
4) How to choose inhaler devices for the treatment of COPD
Pages 10-20
*Walter Vinckena, PN Richard Dekhuijzenb, Peter Barnesc, on behalf of the ADMIT Groupd
a
Respiratory Division, UZ Brussels, Laarbeeklaan 101, Brussels, Belgium
b
Department of Pulmonary Diseases, University Medical Centre Nijmegen, Nijmegen, Netherlands
c
Department of Thoracic Medicine, National Heart and Lung Institute, London, UK
d
Members of the Aerosol Drug Management Improvement Team (ADMIT): Graham K Crompton, Edinburgh, UK, (Chair); Peter J Barnes, London, UK; Marielle Broeders, Nijmegen, The Netherlands; Lorenzo Corbetta, Università degli Studi di Firenze, Italy; Chris Corrigan, London, UK; Richard Dekhuijzen, Nijmegen, The Netherlands; Jean Christophe Dubus, Marseille, France; Thomas Hausen, Essen, Germany; Meinhard Kneussl, Vienna, Austria; Federico Lavorini, Università degli Studi di Firenze, Italy; Mark L Levy, Edinburgh, UK; Søren Pedersen, Kolding, Denmark; Antonio Ramalho de Almeida, Portugal; Joaquin Sanchis, Barcelona, Spain; José L Viejo, Hospital General Yagüe de Burgos, Spain; Walter Vincken, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Thomas Voshaar, Moers, Germany.
Received 28 November 2008 • Accepted 27 August 2009 • Online 4 November 2009
Abstract
For patients with COPD, inhalation is the preferred route of administration of respiratory drugs for both maintenance and acute
treatment. Numerous inhaler types and devices have been developed, each with their own particularities, advantages and disadvantages.
Nevertheless, published COPD management guidelines pay little attention to the optimal choice of inhaler devices for COPD patients.
Although efficacy and safety are the primary factors determining the choice of an inhaler device, randomised controlled trials (RCTs)
directly comparing the efficacy and safety of different inhalers in COPD patients are scarce. Systematic reviews on this subject failed to
find significant differences between devices for any of the clinical outcomes studied. When selecting a device for the delivery of inhaled
drugs in ‘real life’ patients with COPD, other factors should be considered. These include availability and affordability of the inhaled drugs
and inhaler devices, the uniformity of inhaler devices when several drugs are to be inhaled, the ability of patients to handle correctly the
selected device – in particular taking into account the advanced age of the average COPD patient, and finally the patient’s preference.
The prescribing clinician’s task is to provide comprehensive instructions for correct handling of the device and to review regularly the
patient’s inhalation technique.
Keywords
Inhaler devices, inhalation therapy, chronic obstructive pulmonary disease, treatment
* Corresponding author. Walter Vincken Tel: +32-2-4776841 Fax: +32-2-4776840 Email: walter.vincken@uzbrussel.be | |
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