The GOLD strategy has also recognized the importance of delivering more than one drug via a single inhaler device, especially in light of the evidence that use of multiple devices requiring different inhalation techniques diminishes the effectiveness of therapy. Finally, before concluding that the current treatment is insufficient, inhaler technique (and adherence to therapy) should be reviewed. Regular reassessment of inhaler technique has been recommended to improve long-term therapeutic outcomes. Following careful device selection tailored to individual patient needs and abilities, the importance of initial education and training in inhaler device technique is emphasized.
Moreover, for the first time, GOLD 2019 has recommended to consider switching molecules and/or inhaler devices within classes to improve response/outcomes. The current GOLD strategy has explicitly recognized the importance of inhaler choice and instructions in the context of COPD management. Starting with LABA/LAMA combination therapy is recommended on the basis of the greater efficacy of this therapy in improving lung function, symptoms, quality of life, and in reducing exacerbations when compared to monotherapy or to LABA/inhaled corticosteroid (ICS) combinations in these patients. GOLD recommends the combination of a long-acting β-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) as the first-line treatment for patients in GOLD groups B and D, i.e., patients with high symptom burden and those who are at a greater risk of exacerbations, respectively. Inhaled therapy is fundamental in all classes of COPD patients. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report provides a strategy for the assessment and management of COPD and suggests categorizing these patients into four groups, A–D, based on symptoms and exacerbation history. The significant economic burden imposed by COPD continues to increase both in terms of direct and indirect healthcare costs. By 2030, COPD is projected to be the third leading cause of mortality globally. COPD affects an estimated 210 million people worldwide. The preparation of this manuscript was funded by Novartis Pharma AG.Ĭhronic obstructive pulmonary disease (COPD) is an increasingly common respiratory disease caused by substantial long-term exposure to noxious particles or gases and marked by persistent respiratory symptoms and airflow limitation. The introduction of new LABA/LAMA FDCs, new inhaler devices, and more clinical studies have created confusion among physicians in choosing the optimal inhaled therapy for COPD patients in this context, this review attempts to provide an evidence-based framework for informed decision-making with a particular focus on the inhaler devices.įunding. This review objectively examines and compares the major inhaler devices used to deliver different LABA/LAMA FDCs, discusses the inhaler device characteristics that determine drug deposition in the airways, real-life preference for inhaler devices, and handling of inhaler devices that impact the results of the long-term management of COPD. Optimal disease control is also highly dependent upon patient preferences and adherence to inhaler devices.
In this regard, global COPD treatment guidelines have recognized the importance of inhaler devices as integral contributors to the effectiveness of LABA/LAMA FDCs and recommend regular assessment of inhaler device use by the patients in order to improve long-term clinical outcomes. Inhaled fixed-dose combinations (FDCs) of a long-acting β-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) have become the cornerstone for the maintenance treatment of symptomatic COPD patients.
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