Choosing Inhaler Devices in COPD: David Halpin, MA, DPhil

Clinicians should be familiar with the inhalers they prescribe, keep up with newer devices, and limit the number of different devices patients use, according to David Halpin, MA, DPhil, MBBS, consultant physician and senior lecturer in respiratory medicine at the University of Exeter.

In an interview with The American Journal of Managed Care^®, Halpin discussed the strengths and limitations of inhaler devices, the advantages of single-inhaler therapy for chronic obstructive pulmonary disease (COPD), and how prescribers and pharmacists can help patients use their devices correctly.

Why Clinicians Must Know Their Devices

“It’s really important if a clinician is prescribing an inhaler that they’re familiar with it,” Halpin said, including knowing how to teach a patient to use it correctly. He added that a familiar device may have limitations, and alternative devices may offer advantages.

Keeping up to date is difficult, particularly for clinicians in general practice rather than specialist practice, according to Halpin. Inhaler technology is advancing all the time, so clinicians should ask companies and their representatives about new devices and read the literature.

Why Fewer Inhalers Help Patients

Patients who use more than one inhaler, particularly devices that require different priming procedures or inhalation maneuvers, are much more likely to make mistakes and forget how to use them correctly, Halpin noted.

“There’s no doubt that a single inhaler has theoretical advantages over multiple,” he said.

Halpin explained that studies comparing triple therapy in a single inhaler with triple therapy in multiple inhalers showed that the single inhaler was more efficacious and that adherence was also better over time.

Dosing schedules matter as well. Patients may have some treatments to use once daily and others twice daily, so prescribers should try to keep regimens to the same interval, ideally once a day, because it is easier for patients to remember.

How Prescribers and Pharmacists Can Help

When a patient is prescribed more than one device, it is important to explain how the new device differs from the one already in use, Halpin said. That includes whether the patient needs a different inhalation maneuver, a different priming step, or whether the drug has to be loaded into the device or is preloaded.

Halpin said this is the responsibility of the prescriber and also of the dispenser.

“Pharmacists have a key role here in helping patients know how to use their devices correctly,” he concluded.