A clinician’s guide to single vs multiple inhaler therapy for COPD

ABSTRACT

Introduction

In the management of chronic obstructive pulmonary disease (COPD), inhalation therapy plays a pivotal role. However, clinicians often face the dilemma of choosing between single and multiple inhaler therapies for their patients. This choice is critical because it can affect treatment efficacy, patient adherence, and overall disease management.

Areas covered

This article examines the advantages and factors to be taken into consideration when selecting between single and multiple inhaler therapies for COPD.

Expert opinion

Both single and multiple inhaler therapies must be considered in COPD management. While single inhaler therapy offers simplicity and convenience, multiple inhaler therapy provides greater flexibility and customization. Clinicians must carefully evaluate individual patient needs and preferences to determine the most appropriate inhaler therapy regimen. Through personalized treatment approaches and shared decision-making, clinicians can optimize COPD management and improve patient well-being. Nevertheless, further research is required to compare the effectiveness of single versus multiple inhaler strategies through rigorous clinical trials, free from industry bias, to determine the optimal inhaler strategy. Smart inhaler technology appears to have the potential to enhance adherence and personalized management, but the relative merits of smart inhalers in single inhaler regimens versus multiple inhaler regimens remain to be determined.

KEYWORDS:

• Chronic obstructive pulmonary disease
• cost-effectiveness
• inhaler therapy
• multiple inhalers
• patient adherence
• shared decision-making
• single inhaler
• treatment customization
• treatment goals

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Article highlights

• Inhalation therapy is a cornerstone of COPD management, with treatment typically involving a combination of inhaled bronchodilators and corticosteroids, often escalating to triple therapy in severe cases to relieve symptoms and reduce the risk of exacerbations.

• Clinicians are often faced with the challenge of choosing between single and multiple inhaler therapy for their patients. This decision is critical as it can affect treatment efficacy, patient compliance, and overall disease management.

• Single inhaler therapy involves using a single inhaler device that contains multiple medications, simplifying administration, minimising confusion, improving patient adherence, and offering benefits such as convenience, efficacy, and cost effectiveness.

• The use of separate inhalers for different drugs facilitates personalised treatment regimens tailored to individual patient needs, which proves advantageous when specific drug combinations are required but not available in fixed-dose formulations, or when patients have different inhaler preferences.

• When considering multiple inhaler therapy, it is important to consider several key factors, including flexibility, personalisation, side-effect reduction, economic and cultural factors, and implications for the carbon footprint and broader environmental impact.

• Choosing the right inhaler therapy approach for COPD patients is critical to treatment success, but the debate about single versus multiple inhalers is complex. The decision must balance individual patient factors, treatment goals and clinical evidence, and consider patient preferences, skills, beliefs about the need for medication and demographic influences on inhaler technique.

• Further research is needed to conduct thorough clinical trials, free from industry bias, to compare the efficacy of single versus multiple inhaler strategies and to determine the optimal approach.

• While smart inhaler technology holds promise for improving adherence and personalised treatment, its comparative advantages in single versus multiple inhaler regimens remain to be established.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.