HOW I DO IT Selecting An Inhaled Delivery System in COPD.

Challenges facing health care professionals (HCPs) in selecting an inhaled medication-delivery system for patients with chronic obstructive pulmonary disease (COPD) include: 1. numerous maintenance medications and combinations; 2. at least 22 different handheld inhaler devices; 3. management recommendations focusing mainly on classes of medications; 4. lack of knowledge about available medications/combinations, delivery systems, and guidelines/expert recommendations for treating patients with COPD; 5. in some countries, contracts between health insurance and pharmaceutical companies limit which medications-devices are covered. In this article we address three considerations for HCPs related to treating patients with COPD: selecting an inhaled delivery system; assessing whether the inhaled medication-device has provided symptomatic benefit; and providing educational materials for patients on how to use their prescribed medication-device correctly. Four patient cases are presented to illustrate these clinical aspects. The main patient factors for selecting an inhaled delivery system include cognitive function, manual dexterity, and inhalation ability. Continuity of the type of handheld inhaler can be beneficial if the patient is using it correctly. To assess the efficacy of the inhaled medication-device at follow-up, HCPs can ask the patient, "Does your current treatment help your breathing?" If the response is Yes, it is appropriate to continue the therapy and to also review inhaler technique; if the response is No, then the next step is to assess the patient's inhaler technique as well as adherence. If the patient demonstrates and/or describes good technique, is adherent, and does not report subjective benefit, it is reasonable to change the medication and/or device.