Choosing inhaler devices for people with asthma

current knowledge and outstanding research needs

John Haughney, David Price, Neil C. Barnes, J. Christian Virchow, Nicolas Roche, Henry Chrystyn

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

Recommendations in asthma guidelines presuppose that practitioners have the evidence, information, knowledge, and tools to select inhaler devices appropriate for individual patients. Randomised controlled trials usually exclude patients with suboptimal inhaler technique. There is therefore little evidence on which to base inhaler selection in the real world, where patients often use their inhalers incorrectly. The lung deposition of inhaled drug varies according to inhaler device, drug particle size, inhalation technique, and pattern of inspiratory flow. Even with training, not all patients can use their inhalers correctly and maintain inhaler technique; patients may have inability to handle the inhaler, strong negative preferences, or natural breathing patterns that do not match their prescribed inhaler. Therefore, matching device to the patient may be a better course of action than increasing therapy or training and retraining a patient to use a specific inhaler device. Several research questions require answers to meet the goal of helping prescribers make a more informed choice of inhaler type. Is the level of drug deposition in the lungs a key determinant of clinical short- and long-term outcomes? What should be measured by a clinical tool designed to check inhaler technique and therefore help with device selection? If we have a tool to help in individualising inhaler choice, will we achieve better asthma outcomes? Do we have to refine inhaler device choice for each individual, or will we get better outcomes if we select our current best option in light of current knowledge and apply this on a population level?
Original languageEnglish
Pages (from-to)1237-1245
Number of pages9
JournalRespiratory Medicine
Volume104
Issue number9
Early online date15 May 2010
DOIs
Publication statusPublished - Sep 2010

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Nebulizers and Vaporizers
Asthma
Equipment and Supplies
Research
Pharmaceutical Preparations
Lung
Particle Size
Inhalation
Respiration

Keywords

  • asthma control
  • inhaler device
  • inhaler technique
  • primary care
  • tool

Cite this

Choosing inhaler devices for people with asthma : current knowledge and outstanding research needs. / Haughney, John; Price, David; Barnes, Neil C.; Virchow, J. Christian; Roche, Nicolas; Chrystyn, Henry.

In: Respiratory Medicine, Vol. 104, No. 9, 09.2010, p. 1237-1245.

Research output: Contribution to journalArticle

Haughney, John ; Price, David ; Barnes, Neil C. ; Virchow, J. Christian ; Roche, Nicolas ; Chrystyn, Henry. / Choosing inhaler devices for people with asthma : current knowledge and outstanding research needs. In: Respiratory Medicine. 2010 ; Vol. 104, No. 9. pp. 1237-1245.
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