Personalizing Selection of Inhaled Delivery Systems in COPD.

It can be challenging for health care professionals (HCPs) to prescribe inhaled therapy for patients with chronic obstructive pulmonary disease (COPD) due to the multiple individual and combinations of inhaled medications available in numerous delivery systems. Guidance on selection of an inhaled delivery system has received limited attention compared with the emphasis on prescribing the class of the inhaled molecule(s). Although numerous recommendations and algorithms have been proposed to guide selection of an inhaled delivery system for patients with COPD, no specific approach has been endorsed in COPD guidelines/strategies or by professional organizations. To provide recommendations for an inhaler selection strategy at initial and follow-up appointments, we examined the impact of patient errors using hand held inhalers on clinical outcomes and performed a focused narrative review to consider patient factors (continuity of the inhaled delivery system, cognitive function, manual function/dexterity, and peak inspiratory flow) when selecting an inhaled delivery system. Based on these findings, five questions are proposed for HCPs to consider in the initial selection of an inhaler delivery system and three questions to consider at follow-up. We propose that HCPs consider the inhaled medication-delivery system as a unit and to match an appropriate medication(s) with the unique features of the delivery system to individual patient factors. Assessment of inhaler technique and adherence along with patient outcomes/satisfaction at each visit is essential to determine whether the inhaled medication-delivery system is providing benefits. Continued and repeated education on device features and correct technique is warranted to optimize efficacy.