Use of breath-actuated inhalers in patients with asthma and COPD – an advance in inhalational therapy: a systematic review

Abstract

The pressurized metered dose inhalers and dry powder inhalers are the most widely used devices for inhalation therapy in asthma and chronic obstructive pulmonary disease; each of these devices have certain advantages and disadvantages that impact their use. Motivation from the virtues of these devices led to the development of breath-actuated or breath-activated metered dose inhalers. A history of the breath-actuated inhalers, the development and technical aspects, studies about the usability, inhalation technique and patient preference, lung deposition and impact on lung function are presented in this review article. This review presents the use of breath-actuated inhalers in asthma and chronic obstructive pulmonary disease and in children and elderly; and a brief economic evaluation aims to put the clinical efficacy and ease-of-use of the breath-actuated inhaler into perspective by understanding the long-term cost benefits associated with this device.

Keywords::

• asthma
• breath-actuated inhaler
• breath-activated metered dose inhaler
• COPD

Financial & competing interests disclosure

S Salvi is the Director of Chest Research Foundation, an autonomous research institute, B Aggarwal and J Gotay have worked with Cipla Pharmaceuticals Limited. The authors have no other 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 apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• It is unlikely that significant major innovations in pharmacotherapy for asthma and chronic obstructive pulmonary disease will occur in the close future, and hence the focus should be on existing medications and newer improved approaches to delivering these to the lungs.

• The benefits of an inhaler device need to be mapped not only in terms of improved drug delivery, reduced wastage and improved adherence but also in terms of patient preference, satisfactions and ease of use.

• It is important to understand inhaler devices in the ‘real-world setting’ in patients with asthma and chronic obstructive pulmonary disease, in children and in the elderly; after their efficacy and safety has been established in clinical studies.

• There is a need for further clinical trials, health-related outcomes research studies and for the development of more medications/formulations in the breath-actuated inhaler device.

• The main impediment to the widespread use of breath-actuated inhalers despite their potential long-term advantages include, the higher procurement cost per unit of the device.

• Guidelines need to establish patients into different segments that would benefit from a particular type of device including the powdered metered dose inhaler, dry powder inhaler and breath-actuated inhaler.

Notes