News

Friday, 29. June 2012

The role of nebulised therapy in the management of COPD:

Evidence and recommendations

On one hand, the successful therapy of COPD (chronic obstructive obstructive
Increased resistance in the airways that reduces the amount of air inhaled in each breath and the oxygen that reaches the pulmonary arteries
pulmonary disease) is based on the patient´s ability to use an inhaler correctly. On the other, it is very important to take patient preferences into account.

For this reason physicians are faced with the task to choose the most suitable delivery system for their patients: metered dose inhaler metered dose inhaler
MDI: A metered-dose inhaler (MDI) is a device that delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation.
(MDI MDI
A metered-dose inhaler (MDI) is a device that delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation.
), dry powder inhaler dry powder inhaler
A dry powder inhaler (DPI) is a device that delivers medication to the lungs in the form of a dry powder.
(DPI DPI
A dry powder inhaler (DPI) is a device that delivers medication to the lungs in the form of a dry powder.
) or a nebuliser?

A recently published clinical review gives clear recommendations for situations in which COPD-medications should be inhaled with a nebuliser:

● Elderly patients, particularly over 65 years of age

● Patients with severe COPD and frequent exacerbations (worsening of

   symptoms)

● Patients who have physical and/or cognitive limitations

● During exacerbations, especially when higher doses are required

● Patients who don't show symptomatic improvements despite the proper use

   of MDIs and DPIs

● Patients who prefer nebulised therapy over other inhalers

The American Group of Authors conclude: 

In maintenance therapy in patients with COPD better clinical outcomes could be expected for patients who prefer nebulisers or have difficulties using MDIs or DPIs

1Dhand et al., COPD 2012, 9:58-72