Use of pressurized metered dose inhalers in patients with chronic obstructive pulmonary disease: review of evidence

Abstract

The inhaled route is considered to be the best route to administer drugs for treating respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD), for both safety and efficacy. Inhalation devices are classified into four types – pressuriszed metered dose inhalers (pMDIs), dry powder inhalers, breath actuated inhalers and nebulizers. pMDIs are portable, convenient, multi-dose devices and these advantages have made them very popular with patients. They were introduced in the 1950s as the first portable, multi-dose delivery system for bronchodilators. Even though pMDIs are the most widely used devices for inhalation therapy in asthma and COPD, studies establishing their use and providing clinical data with bronchodilators and combination therapies in patients with COPD are limited. A summary of the use of pMDI with spacers in patients with COPD in terms of lung deposition and impact on lung function are presented in this review article. A review of use of the pMDI device in patients with COPD with different available and prescribed medications (bronchodilators-β₂-agonists and anticholinergics, and their combination with inhaled corticosteroids) is discussed.

Keywords::

• chronic obstructive pulmonary disease
• inhalation
• pressurized metered-dose inhaler
• pressurized metered dose
• spacers

Financial & competing interests disclosure

Dr Aggarwal and Jaideep have affiliations with Cipla Pharmacetuicals Limited. The authors have other 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.

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

Key issues

• Two key challenges for patients with chronic obstructive pulmonary disease (COPD) using pressurzed metered-dose inhalers (pMDIs) are the issues of coordination of actuation with inhalation and how to know when to replace their inhaler.

• And so, although the pMDI has the advantages of being economic and portable, it should be seen important by manufacturers, physicians and regulatory authorities to mandate the use of spacers with the device and the addition of an accurate dose counter to help patients track the number of doses and improve patient satisfaction.

• The benefits and rational use of pMDI in different patient segments need to be established including children and elderly and those with impaired inspiratory flow rates.

• There is clearly a need for well-designed randomized controlled trials with adequate sample size to define the role of pMDI with spacers for administering bronchodilators and their combination with inhaled corticosteroids in patients with COPD.

• Additionally, efficacy of pMDI with spacers on exacerbations, health-related quality of life and patient-related outcomes needs to be studied.

• Once this evidence is generated and published, guidelines can then put this into perspective, establishing the role and the patient population with the COPD patients that would clearly be the most benefitted from the use of pMDI with spacer.

Notes