J Korean Med Assoc.  2013 Jul;56(7):625-631. 10.5124/jkma.2013.56.7.625.

Inhalation medications in chronic airway disease

• Yoo KH

• KMID: 2193052
• DOI: http://doi.org/10.5124/jkma.2013.56.7.625

Abstract

Chronic airway diseases (asthma and chronic obstructive lung disease) are common and their prevalence is increasing worldwide. The most effective method for drug delivery for the treatment of patients with chronic airway diseases is via an inhaler device. The guidelines on asthma and chronic obstructive pulmonary disease (COPD) recommend inhaler medication for the treatment of these patients. Inhaled medications have several advantages, including faster onset of action, a lower dose of medicine, and reduced adverse effects. To maximize the effect of inhaled medication, patients must use the inhaler device correctly; thus patients should receive training and education in the use of the device. There are now many kinds of inhaler devices on the market, such that the appropriate choice of inhaler device for each patient plays a crucial role in achieving a good outcomes from treatment. Correct use of inhalation devices will maximize the beneficial effects of therapy. A detailed assessment of the patient's coordination and inspiratory flow patterns could allow for the correct use of the most suitable inhaler medication for each patient. Successful inhalation therapy can increase the possibility of controlling airway diseases.

Keyword

Inhaler medication; Asthma; Chronic obstructive pulmonary disease; Equipment and supplies

MeSH Terms

Asthma
Equipment and Supplies
Humans
Inhalation
Lung
Nebulizers and Vaporizers
Prevalence
Pulmonary Disease, Chronic Obstructive
Respiratory Therapy

Figure

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  Figure 1 Treatment options for stable chronic obstructive lung disease patients. FEV1, forced expiratory volume at 1 second; pred, predicted; mMRC, modified medical research council; CAT, chronic obstructive pulmonary disease assessment test; LABA, long acting beta-2 agonist; LAMA, long acting muscarinic antagonist; ICS, inhaled corticosteroid; PDE4, phosphodieserase4. a)Including 24 hours LABA. b)FEV1<50% pred., chronic cough, History of acute exacerbation. From Korean Academy of Tuberculosis and Respiratory Disease. COPD: the guideline for treatment. 2nd ed. Seoul: Korean Academy of Tuberculosis and Respiratory Disease; 2012, with permission from Korean Academy of Tuberculosis and Respiratory Disease [6].

Reference

1. Global Initiative for Asthma. Global strategy for asthma management and prevention [Internet]. [place unknown]: Global Initiative for Asthma;2011. cited 2013 Jun 24. Available from: http://ginasthma.org/local/uploads/files/GINA_Report2011_May4.pdf.

2. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD [Internet]. [place unknown]: Global Initiative for Chronic Obstructive Lung Disease;cited 2013 Jun 24. Available from: http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html.

3. Yoo KH, Kim YS, Sheen SS, Park JH, Hwang YI, Kim SH, Yoon HI, Lim SC, Park JY, Park SJ, Seo KH, Kim KU, Oh YM, Lee NY, Kim JS, Oh KW, Kim YT, Park IW, Lee SD, Kim SK, Kim YK, Han SK. Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008. Respirology. 2011; 16:659–665.

4. Hwang YI, Yoo KH, Sheen SS, Park JH, Kim SH, Yoon HI, Lim SC, Lee SY, Park JY, Park SJ, Seo KH, Kim KU, Lee SY, Park IW, Lee SD, Kim SK, Kim YK, Lee SM, Han SK, Kim Y, Cho YM, Park HJ, Oh KW, Kim YS, Oh YM. Prevalence of chronic obstructive pulmonary disease in Korea: the result of forth Korean national health and nutrition examination survey. Tuberc Respir Dis. 2011; 71:328–334.

5. Korean Academy of Asthma, Allergy and Clinical Immunology. Korean asthma management guideline for adults. 2nd ed. Seoul: Korean Academy of Asthma, Allergy and Clinical Immunology;2011.

6. Korean Academy of Tuberculosis and Respiratory Disease. COPD: the guideline for treatment. 2nd ed. Seoul: Korean Academy of Tuberculosis and Respiratory Disease;2012.

7. Camilli AE, Robbins DR, Lebowitz MD. Death certificate reporting of confirmed airways obstructive disease. Am J Epidemiol. 1991; 133:795–800.

8. Everard ML. Guidelines for devices and choices. J Aerosol Med. 2001; 14:Suppl 1. S59–S64.

9. Jeong JW, Chang YS, Kim CW, Kim TB, Kim SH, Kwon YE, Kang HR, Jeong YY, Park JW, Jee YK. Assessment of techniques for using inhalers in primary care physicians. Korean J Asthma Allergy Clin Immunol. 2011; 31:116–123.

10. Nimmo CJ, Chen DN, Martinusen SM, Ustad TL, Ostrow DN. Assessment of patient acceptance and inhalation technique of a pressurized aerosol inhaler and two breath-actuated devices. Ann Pharmacother. 1993; 27:922–927.

11. Haughney J, Price D, Barnes NC, Virchow JC, Roche N, Chrystyn H. Choosing inhaler devices for people with asthma: current knowledge and outstanding research needs. Respir Med. 2010; 104:1237–1245.

12. Leach C, Colice GL, Luskin A. Particle size of inhaled corticosteroids: does it matter? J Allergy Clin Immunol. 2009; 124:6 Suppl. S88–S93.

13. Newman SP. Aerosol deposition considerations in inhalation therapy. Chest. 1985; 88:2 Suppl. 152S–160S.

14. Bell J. Why optimise inhaler technique in asthma and COPD? Br J Prim Care Nurs. 2008; 2:37–39.

15. Usmani OS, Biddiscombe MF, Barnes PJ. Regional lung deposition and bronchodilator response as a function of beta2-agonist particle size. Am J Respir Crit Care Med. 2005; 172:1497–1504.

16. Chrystyn H. Is inhalation rate important for a dry powder inhaler? Using the In-Check Dial to identify these rates. Respir Med. 2003; 97:181–187.

17. Borgstrom L, Bondesson E, Moren F, Trofast E, Newman SP. Lung deposition of budesonide inhaled via Turbuhaler: a comparison with terbutaline sulphate in normal subjects. Eur Respir J. 1994; 7:69–73.

18. Ho SF, OMahony MS, Steward JA, Breay P, Burr ML. Inhaler technique in older people in the community. Age Ageing. 2004; 33:185–188.

19. Bloomfield P, Crompton GK, Winsey NJ. A tube spacer to improve inhalation of drugs from pressurised aerosols. Br Med J. 1979; 2:1479.

20. Fabbri LM, Nicolini G, Olivieri D, Papi A. Inhaled beclometasone dipropionate/formoterol extra-fine fixed combination in the treatment of asthma: evidence and future perspectives. Expert Opin Pharmacother. 2008; 9:479–490.

21. Gabrio BJ, Stein SW, Velasquez DJ. A new method to evaluate plume characteristics of hydrofluoroalkane and chlorofluorocarbon metered dose inhalers. Int J Pharm. 1999; 186:3–12.

22. Newman SP, Weisz AW, Talaee N, Clarke SW. Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. Thorax. 1991; 46:712–716.

23. Lenney J, Innes JA, Crompton GK. Inappropriate inhaler use: assessment of use and patient preference of seven inhalation devices. EDICI. Respir Med. 2000; 94:496–500.

24. Dalby R, Spallek M, Voshaar T. A review of the development of Respimat Soft Mist Inhaler. Int J Pharm. 2004; 283:1–9.

25. Voshaar T, App EM, Berdel D, Buhl R, Fischer J, Gessler T, Haidl P, Heyder J, Kohler D, Kohlhaufl M, Lehr CM, Lindemann H, Matthys H, Meyer T, Olschewski H, Paul KD, Rabe K, Raschke F, Scheuch G, Schmehl T, Schultze-Werninghaus G, Ukena D, Worth H. Arbeitsgruppe Aerosolmedizin der Deutschen Gesellschaft fur Pneumologie. Recommendations for the choice of inhalatory systems for drug prescription. Pneumologie. 2001; 55:579–586.

26. Yu SK, Park SI, Park SY, Park JK, Kim SE, Kim JY, Shin KC, Chung JH, Lee KH. The effect of repeated education using a computerized scoring system for the proper use of inhalation medicine. Tuberc Respir Dis. 2007; 63:491–496.