Monday, 04. April 2011

Advancing the pulmonary specialist’s knowledge of inhalation therapies

A new European Consensus Paper helps specialists choose the best delivery system as there are a vast number of technical solutions on the market for efficient inhaled drug therapy

The paper focused on handling aspects of different delivery systems for treating respiratory patients at home as well as in the hospital setting1. The guideline aimed at providing physicians and healthcare professionals with a basis for making sound clinical decisions by asking: What system is most suitable for my patient?

The publication, authored by recognized pulmonary experts, highlights the complexity of inhalation therapy. Many factors play a role in achieving effective treatment including: the performance of the individual system, the characteristics of the active drug, the patient’s disease severity, breathing pattern, and the ability to use the device correctly. Further, other factors are often overlooked, such as the creativity of some patients once they are at home. Often enough they do not recall all treatment instructions prescribed by their healthcare provider and subsequently do things quite differently from what they were taught in the medical office. This practice may lead to undesirable treatment outcomes.

As a rule, efficient therapy is feasible with all available systems. However, this holds true only if they are administered correctly. This is not always the case in practice, especially with the use of metered dose inhalers (MDI). Under daily real-life conditions error rates higher than 70% have been observed for these small and convenient inhalers2.

The situation does improve if an inhalation aid such as a valved holding chamber (VHC) is added to the treatment. Nebulizers may also prove very useful, particularly if a patient has difficulties with correct inhalation technique.

While device selection should be made on an individual basis for each patient, one expert’s recommendation applies to all delivery systems: whenever possible one inhalation system should be used and patients should not be switched to new devices without their involvement and proper education. Taking this approach will ensure good inhalation technique and hence improve the success of patients receiving efficient therapy.


  1. Laube et al. 2011 ERJ Express. Published ahead of print on Feb 10
  2. Molimard et al. 2003 J Aerosol Med 16: 249-254