Treatment of COPD requires regular use of inhaled medication. As such, choosing an appropriate inhaler device is crucial for successful patient outcomes.
Portable inhalers are categorized as pressurized metered-dose inhalers (MDIs), dry powder inhalers, and soft mist inhalers. Pressurized MDIs use a propellant to atomize the drug, which is then ideally inhaled into the lungs. Patients must coordinate inhalation with inhaler actuation; otherwise, the drug is deposited in the oropharynx (where subsequent ingestion may cause systemic adverse events) instead of the lungs. Breath-actuated, pressurized MDIs bypass the need for coordination by releasing the drug in response to inhalation, but patients may still inhale too quickly, struggle to inhale deeply enough, fail to hold their breath long enough for effective drug delivery, or a combination of these concerns.
Dry powder inhalers rely on the patient’s inhalation to atomize the drug. However, many patients with COPD cannot inhale forcefully enough to achieve effective drug delivery. Furthermore, these types of inhalers are susceptible to heat and moisture, thereby limiting their use in hot and humid ambient environments.
Soft mist inhalers overcome limitations of pressurized MDIs and dry powder inhalers by reducing the need for coordination, avoiding propellants, and decreasing the required inspiratory effort. A compressed spring inside the inhaler delivers the drug as a slow-moving, longer-lasting aerosol mist that requires less coordination to inhale, whereas the small size of the drug particles facilitates deposition in smaller airways. Together, these characteristics provide consistent drug delivery to the lungs and reduced oropharyngeal deposition.
Do you consider inhaler characteristics when selecting a treatment option for your patients with COPD?
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Matthew Hegewald2yrYes. We check inspiratory flow rates with in-check device before using a DPI
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Thomas Hawkey2yrYes, patient dexterity plays a big role in choosing an inhaler type
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Darin Skaudis, Physician2yrYes, I consider the type of inhaler, medication, patient preference, ability to produce an effective negative inspiratory pressure and dexterity.
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SENTHIL RAGHAVAN2yrInhaler characteristics is very important factor in deciding which type on inhaler I use. The mode of delivery will decide the efficacy of the drug especially in certain patient populations
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Jason Beasley, MD2yrI consider an inhaler's characteristics with each individual patient, taking into account the patient's inspiratory capacity, dexterity, and cognition. I also consider a patient's preference for a type of inhaler.
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Matthew Shore, Family Medicine2yrYes, I consider the type of inhaler, medication, patient preference and manual dexterity
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BRITTANY LITTLE2yrYes! I consider dexterity, cognition, and inspiratory capacity when prescribing inhalers.
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CHRISTOPHER COMPTON2yrPatient prefer certain inhaler device. Sometimes other medical problem dictate which inhaler device to use. Fine mist inhaler is typically easier to use, next is dry powder and hardest to use is traditional inhaler device. Nebulizers are not very portable.
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Richard Nguyen2yrYes, I definitely consider inhaler characteristics for my patients. I take into consideration easy of use (patient dexterity, inhalation technique), device type (MDIs, DPIs, Soft Mist Inhalers (SMIs), medication delivery (consistency, particle size), patient preference (comfort and convenience, ensuring patient receives proper training on use), adherence monitoring, severity of disease, comorbidities, frequency of use.
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ANTHONY FRITZ2yrI use a powdered inhaler routinely for at home and a portable rescue inhaler for rapid efficacy and ease of portability
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Vincent Gimino2yrI frequently consider the inhaler characteristics. Many patients by the time they get to us have had some history with many medications, and therefore have some favorable/unfavorable choices and experiences. Those are taken into consideration. Then there is the patient's ability to use one device vs another, based on dexterity, or PIFR. Unfortunately, even with all good and well supported intentions, the insurance company coverage will undermine those decisions.
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Kenneth Chinsky, Chest Diseases/Allegheny Health Network2yrYes, I consider inhaler device as well. Sometimes there's a patient preference. Other times considerations like musculoskeletal issues, neurologic conditions, etc that affect ability to use device properly. Others are intolerant of dry powder. I do take into account patient inspiratory flow issues as well.
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Mitchell Ahrens2yrPart of the assessment for choice of therapy really is patient dependent. Majority of patients with training MDI would be quickest & easiest option. DPI inhalers overcome the hand breath coordination but need to assess the inhalation cycle of the patient. Soft mist fairly straightforward but still can be an hand-breath issue or dexterity issue.
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Bing Xue2yrYes I do consider inhalers devices especially in elderly patients or anyone have limited inspiratory effort.
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Robert Tanaka2yrAll prescribers should access the quality of the delivery of aerosol medications by directly observing their patients in the act of giving themselves their medications; do not assume the patients are doing it right all of the time.