Choosing Inhalers

Aspects important for selection of the appropriate device for an individual patient

When selecting an aerosol delivery device the following questions should be considered:

In which device is the desired drug available?

Which device will the patient be able to use correctly, given the patient’s age and clinical setting?

For which device and drug combination is reimbursement available?

Can all types of inhaled drugs prescribed for the patient be delivered by the same type of device?

Which device is most convenient for the patient regarding time of drug administration, device cleaning or portability?

How long can the device be used?

From controlled clinical trials no significant differences appear to exist between different kind of devices concerning their efficacy and tolerability. Therefore it can be assumed that an ideal patient thoroughly instructed in the correct use of his device can be treated successfully with any inhaler. However it has been demonstrated that only very few asthmatics meet the selection criteria of controlled trials. Therefore decision on a particular device cannot be made on the basis of a few predefined patient characteristics but should take into account the individual situation and preference of a certain patient.

Literature:

Dolovich MB, Ahrens RC, Hess RD, Anderson P, Dhand R, Rau JL, Smaldone GC, Guyatt G. Device selection and outcomes of aerosol therapy: evidence-based guidelines. 2005. Chest; 127 (1): 335-371

Herland K, Akselen JP, Skjonsberg OH, Bjermer L. How representative are clinical study patients with asthma or COPD for a larger “real life”? population of patients with obstructive lung disease? 2005. Respiratory Medicine; 99: 11-19