What to Consider When Selecting Inhalers for COPD

Patients with chronic obstructive pulmonary disease (COPD) require daily treatment for the rest of their lives, and inhaled medication is most optimal because it delivers the active drug directly to the lungs while diminishing systemic side effects.

Recently, respiratory specialists examined inhaled medications from 2 perspectives: the choice of the drug and the choice of a delivery device. Their article, which appears online ahead of print in Pulmonary Pharmacology & Therapeutics, is timely because very few documents about COPD or asthma management focus on device-related issues. Similarly, guidelines rarely include criteria for choosing inhaler devices, especially for adults.

The authors advise evaluating COPD patients’ degree of airway obstruction and comorbidities, as well as assessing their dexterity and coordination—both of which are necessary to use inhalers successfully.

Next, they suggest analyzing each inhaler’s specific advantages and limitations. Good evidence indicates that patients can attain their desired therapeutic effect if they use the manufacturer’s recommended inhalation technique. However, this evidence comes from controlled clinical trials where patients receive more than the usual support and education. In real-world situations, patients may require dose adjustments.

In COPD, the particle size delivered by the device is critical, with 2 μm to 5μm being optimal. The type of inhaler is important, but inspiratory flow is also a major determinant of drug delivery.

Although the authors make few specific recommendations, they do report that turbohalers deposit 25% to 40% of the delivered dose, exceeding that of pressurized metered dose inhalers and dry powder inhalers.

In terms of COPD treatment adherence, the authors note that most patients make at least 1 error when using an inhaler, referred to as unwitting nonadherence. Some patients take more missteps, increasing or reducing the amount of medication that reaches their bronchial tree. Thus, the authors stress simplification, demonstration, and repetition.

With the wide selection of available inhalers, this article sheds light on factors that can influence treatment success. It provides a good overview of different inhalers, and an excellent summary of educational approaches.