Virchow J C, Crompton G K, Dal Negro R, Pedersen S, Magnan A, Seidenberg J, Barnes P J
Department of Pneumology, University Medical Clinic, University of Rostock, Rostock, Germany.
Respir Med. 2008 Jan;102(1):10-9. doi: 10.1016/j.rmed.2007.07.031. Epub 2007 Oct 17.
The delivery of drugs by inhalation is an integral component of asthma and chronic obstructive pulmonary disease (COPD) management. However, even with effective inhaled pharmacological therapies, asthma, particularly, remains poorly controlled around the world. The reasons for this are manifold, but limitations of treatment guidelines in terms of content, implementation and relevance to everyday clinical life, including insufficient patient education, access to health care and cost of medication as well as poor inhaler technique are likely to contribute. Considering that inhalation therapy is a cornerstone in asthma and COPD management, little advice is provided in the guidelines regarding inhaler selection. The pressurised metered dose inhaler (pMDI) is still the most frequently prescribed device worldwide, but even after repeated tuition many patients fail to use it correctly. In addition, the correct technique can be lost over time. Although several improvements in pMDIs such as a change in the propellant and actuation have resulted in improvements in lung deposition, many dry powder inhalers (DPIs) are easier to use. However, these devices also have limitations such as dependency of drug particle size on flow rate and loss of the metered dose if the patient exhales through the device before inhaling. Improvements in using inhalation devices more efficiently, in inhaler design for supporting patient compliance, and advances in inhaler technology to assure drug delivery to the lungs, have the potential to improve asthma and COPD management and control. New and advanced devices are considered being helpful to minimise the most important problems patients have with current DPIs.
吸入给药是哮喘和慢性阻塞性肺疾病（COPD）治疗的一个重要组成部分。然而，即便有有效的吸入药物疗法，尤其是哮喘，在全球范围内仍控制不佳。原因是多方面的，但治疗指南在内容、实施以及与日常临床生活的相关性方面存在局限性，包括患者教育不足、获得医疗保健的机会、药物成本以及吸入器使用技术不佳等，这些可能都起到了一定作用。鉴于吸入疗法是哮喘和COPD治疗的基石，指南中关于吸入器选择的建议却很少。压力定量吸入器（pMDI）仍是全球最常处方的装置，但即便经过反复指导，许多患者仍无法正确使用。此外，正确的技术随着时间推移可能会遗忘。尽管pMDI有多项改进，如推进剂的改变和驱动方式的改进，使肺部沉积有所改善，但许多干粉吸入器（DPI）使用起来更简便。然而，这些装置也有局限性，如药物颗粒大小依赖流速，且如果患者在吸气前通过装置呼气，会导致定量剂量损失。在更高效使用吸入装置、设计支持患者依从性的吸入器以及吸入器技术进步以确保药物输送到肺部方面取得进展，有可能改善哮喘和COPD的治疗与控制。新型先进装置被认为有助于最大程度减少患者目前使用DPI时遇到的最重要问题。
