Inhaler choice in primary practice

K. R. Chapman; T. H. Voshaar; J. C. Virchow

doi:10.1183/09059180.05.00009607

Tables

TABLE 1—

Checklist for physician selection of inhalers proposed by a joint committee of the American College of Chest Physicians and American College of Asthma, Allergy and Immunology(adapted from [26] with permission from the publisher)

1	In what devices is the desired drug available?
2	What device is the patient likely to be able to use properly, given the patient's age and the clinical setting?
3	For which device and drug combination is reimbursement available?
4	Which devices are the least costly?
5	Can all types of inhaled asthma/COPD drugs that are prescribed for the patient be delivered with the same type of device?
6	Which devices are the most convenient for the patient, family or medical staff to use given the time required for drug administration and device cleaning, and the portability of the device?
7	How durable is the device?
8	Does the patient or clinician have any specific device preferences?

TABLE 2—

Proposed checklist to guide inhaler selection in primary care

1	In what device is the chosen drug available and affordable for my patient?
2	Who will teach the patient the correct inhaler technique?
3	Does the patient or physician have a preference for one type of device, assuming that the device/drug combination is available, affordable and can be handled correctly by the patient after education?

TABLE 3—

Suitability of the main device types, categorised according to the patient's abilities (adapted from [36] with permission from the publisher)

Good coordination of actuation with inspiration		Poor coordination of actuation with inspiration
Inspiratory flow >30 L·min⁻¹	Inspiratory flow <30 L·min⁻¹	Inspiratory flow >30 L·min⁻¹	Inspiratory flow <30 L·min⁻¹
pMDI	pMDI	pMDI with spacer	pMDI with spacer
Breath-actuated pMDI	Nebuliser (e.g. patient with severe obstruction)	Breath-actuated pMDI	Nebuliser (e.g. small children)
DPI	SMI	DPI	SMI
Nebuliser (e.g. average patient)		Nebuliser (e.g. elderly patients, children)
SMI		SMI