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What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape
Careggi Univ Hosp, Dept Expt & Clin Med, Largo Brambilla 3, I-50134 Florence, Italy.ORCID iD: 0000-0002-3293-2123
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.ORCID iD: 0000-0001-5093-6980
Univ Genoa, IRCCS, Allergy & Resp Dis Clin, DIMI,AOU San Martino IST, Genoa, Italy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
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2019 (English)In: THERAPEUTIC ADVANCES IN RESPIRATORY DISEASE, ISSN 1753-4658, Vol. 13, article id 1753466619884532Article, review/survey (Refereed) Published
Abstract [en]

Inhaled therapies are the cornerstone of treatment in asthma and chronic obstructive pulmonary disease, and there are a multitude of devices available. There is, however, a distinct lack of evidence-based guidance for healthcare providers on how to choose an appropriate inhaler. This review aims to summarise recent updates on topics related to inhaler choice, and to offer practical considerations for healthcare providers regarding currently marketed devices. The importance of choosing the right inhaler for the right patient is discussed, and the relative merits of dry powder inhalers, pressurised metered dose inhalers, breath-actuated pressurised metered dose inhalers, spacers and soft mist inhalers are considered. Compiling the latest studies in the devices therapy area, this review focuses on the most common types of handling errors, as well as the comparative rates of incorrect inhalation technique between devices. The impact of device-specific handling errors on inhaler performance is also discussed, and the characteristics that can impair optimal drug delivery, such as inhalation flow rate, inhalation volume and particle size, are compared between devices. The impact of patient perceptions, behaviours and problems with inhalation technique is analysed, and the need for appropriate patient education is also highlighted. The continued development of technology in inhaler design and the need to standardise study assessment, endpoints and patient populations are identified as future research needs. The reviews of this paper are available via the supplemental material section.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD , 2019. Vol. 13, article id 1753466619884532
Keywords [en]
asthma, COPD, critical errors, dry powder inhaler, inhalation technique, metered dose inhaler
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:uu:diva-401994DOI: 10.1177/1753466619884532ISI: 000501286400001PubMedID: 31805823OAI: oai:DiVA.org:uu-401994DiVA, id: diva2:1384707
Available from: 2020-01-10 Created: 2020-01-10 Last updated: 2020-01-10Bibliographically approved

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