Effectiveness of Asthma Inhaler Pharmacotherapy must take into consideration both the device and drug and which is guided by clinically meaningful outcomes

Abstract

The inhalation route remains the mainstay of therapy for asthma and chronic obstructive pulmonary disease (COPD). This confers a number of advantages such as delivery of medication directly to the site of action resulting in faster onset. It also allows smaller doses to be administered and therefore signifi cantly reduces systemic side effects compared with oral therapy. The drug treatment regime for the majority of patients with asthma and COPD is straightforward and is documented in many guidelines [1-3]. However, the choice of which inhaler device to use is less straightforward. Rather than being spoilt for choice, we are frequently confused by the everincreasing number of devices available. Although inhalation therapy is now the mainstay of asthma treatment, for most patients such treatment is still not optimal. The delivered dose can vary widely between different delivery systems and between patients depending on how well they use a particular device. Many new inhaler devices have become available, and their competing pharmaceutical company promotional claims can confuse both prescribers and patients. This review provides clinical practice recommendations based on evidence to date on the effectiveness of inhaler devices.