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Inhaler choice in primary practice

K. R. Chapman^*, T. H. Voshaar and J. C. Virchow^¶

^* University Health Network, Toronto, ON, Canada, and Dept of Pneumology and Allergy, Medical Clinic III, Bethanien Hospital, Moers, and ^¶ Dept of Pneumology, University Medical Clinic, Rostock, Germany.

CORRESPONDENCE: K. R. Chapman, Asthma and Airway Centre, University Health Network, Room 7E-451, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8. Fax: 1 4166033456. E-mail: kchapman{at}ca.inter.net

A broad range of inhaler devices is available for physicians to prescribe. Although newer devices are often easier to use than conventional pressurised metered-dose inhalers (pMDIs), many patients still use inhalers sub-optimally. Physicians must become familiar with the characteristics of several inhalers and choose the device that their patients can use correctly and beneficially if they are to prescribe successfully to those with chronic obstructive pulmonary disease (COPD). The selection of a device may also be influenced by patient comorbidities and by their ability to handle and inhale correctly from the device. A further challenge in the COPD setting is measuring the desired treatment outcome.

A simple algorithm or checklist can guide device selection in primary care. The device must be affordable for the patient, the patient must be able to handle it correctly and the practitioner or other trained professional should monitor that it is being used correctly. The patient's and physician's preferences should also be taken into account. The most important device-handling skills that should be assessed are whether the patient can: properly prepare and actuate the device; take an adequate inspiration; and coordinate actuation of a pMDI with inspiration.

Testing the practicality and advantages of such checklists will mean better use can be made of the inhaler types currently available as well as newer designs. In the interim, caregiver and patient education are needed.

KEYWORDS: Asthma, chronic obstructive pulmonary disease, deposition, dry powder inhaler, inhaler technique, pressurised metered-dose inhaler