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Respir Med. 2014 May;108(5):694-700. doi: 10.1016/j.rmed.2014.02.013. Epub 2014 Mar 1.

Guidance on handheld inhalers in asthma and COPD guidelines.

Author information

1
Department of Pulmonary Diseases (454), Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: R.Dekhuijzen@LONG.umcn.nl.
2
Department of Respiratory Medicine, Lund University Hospital, SE-22185 Lund, Sweden.
3
Department of Experimental and Clinical Medicine, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.
4
Service de Pneumologie, Saint-Pierre University Hospital Brussels, 322 rue Haute, B-1000 Brussels, Belgium.
5
University of Bordeaux, INSERM U657, 33076 Bordeaux Cedex, France.
6
Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, AB25 2AY Scotland, UK.

Abstract

BACKGROUND:

Inhaled therapy is the cornerstone of pharmacotherapy in patients with asthma and chronic obstructive pulmonary disease (COPD). Appropriate inhalation device selection is as important as drug choice but device-specific guidance appears to be lacking.

METHODS:

To quantify the level of inhalation-device recommendations in clinical guidelines, a review was conducted by hand-searching national and international asthma and COPD guidelines (Global Initiative for Asthma [GINA] and Global initiative for chronic Obstructive Lung Disease [GOLD] guidelines) and an international guideline on device selection (the American College of Chest Physicians/American College of Asthma, Allergy, and Immunology [ACCP/ACAAI]). For each guideline, the number of pages, tables/figures and references relating to inhalation devices was identified.

RESULTS:

GINA and GOLD guidelines contain very little inhalation device-specific guidance beyond recommendations for demonstrating and testing correct inhalation technique: <2% of pages or references and <3% of tables/figures are dedicated to devices. Device-related content in the ACCP/ACAAI device selection guideline was considerably higher with 54% of pages, 88% of tables/figures and 82% of references, respectively. Results in national guidelines reflect those on international guidelines.

CONCLUSIONS:

These results indicate that there is a considerable lack of clear and specific guidance regarding inhalation devices in current asthma/COPD guidelines. More robust studies on the impact of inhalation devices are needed to increase the number of evidence statements and recommendations regarding inhalation devices.

KEYWORDS:

Asthma; Chronic obstructive pulmonary disease; Dry powder inhalers; Guidelines; Pressurised metered-dose inhalers

PMID:
24636812
DOI:
10.1016/j.rmed.2014.02.013
[Indexed for MEDLINE]
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