Melani Andrea S
Respiratory Physiopathology and Rehabilitation, Cardiothoracic Department, Polyclinic Le Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
Acta Biomed. 2007 Dec;78(3):233-45.
Patients with asthma and COPD commonly use inhaled drugs. The 3 types of currently available devices for inhaled therapy (Metered-dose inhaler, dry powder inhaler, and nebulizer) are clinically equivalent. However, since many different inhalers are available for inhaled therapy, the choice of the delivery device is important for optimizing the results of aerosol therapy. Traditional press-and-breathe Metered Dose Inhalers (pMDIs) have recently improved their ecological appeal, can be used in every clinical and environmental situation, their dosing is convenient and highly reproducible, but their efficient delivery remains highly technique dependent. Poor inhalation technique can be minimised by the use of add-on valved holding chambers, which are seldom used in the clinical practice possibly because they are cumbersome. Breath Actuated devices (BAIs), such as Dry Powder Inhalers (DPIs), which are environmental-friendly, safe, effective, reliable, portable and self-contained, overcome problems of handbreath co-ordination associated with pMDIs usage, but their use is also undermined by common errors of inhalation technique in real life. Nebulizers are cumbersome and time-comsuming for use and maintenance, but their use needs less cooperation than inhalers. Although nebulizer practice is not always evidence-based, some patients, mainly elderly prefer nebulizers for regular long-term usage. Despite the introduction of newer devices, clear advantages of a particular delivery system over other inhalers in terms of compliance, preference, and cost-effectiveness are not currently available. The objective of an ideal and easy-to use inhaler is far from reality. Patient education is the critical factor in the use and misuse of delivery devices and effectiveness of aerosol therapy. The choice of the device has to be tailored according to the patient's needs, situation, and preference. Whatever the chosen inhaler, education from health caregivers has a key-role for improving inhaler technique and compliance. Differences among delivery devices represent another challenge to patient use and caregiver instruction.
哮喘和慢性阻塞性肺疾病（COPD）患者通常使用吸入药物。目前可用于吸入治疗的3种装置（定量吸入器、干粉吸入器和雾化器）在临床上等效。然而，由于有许多不同的吸入器可用于吸入治疗，因此选择给药装置对于优化气溶胶治疗效果很重要。传统的按压式定量吸入器（pMDIs）最近在环保方面有所改进，可用于各种临床和环境情况，其给药方便且高度可重复，但有效递送仍高度依赖技术。使用带单向活瓣储雾罐可将不良吸入技术的影响降至最低，但临床实践中很少使用，可能是因为其使用不便。干粉吸入器等呼吸驱动装置（BAIs）环保、安全、有效、可靠、便携且自成一体，克服了与使用pMDIs相关的手-呼吸协调问题，但在现实生活中，常见的吸入技术错误也会影响其使用。雾化器使用和维护起来既麻烦又耗时，但其使用所需的配合比吸入器少。尽管雾化器的使用并不总是有循证依据，但一些患者，主要是老年人，更喜欢长期定期使用雾化器。尽管推出了更新的装置，但目前尚无一种特定给药系统在依从性、偏好和成本效益方面明显优于其他吸入器。理想且易于使用的吸入器这一目标仍远未实现。患者教育是给药装置使用和误用以及气溶胶治疗效果的关键因素。必须根据患者的需求、情况和偏好来选择装置。无论选择何种吸入器，医护人员的教育对于提高吸入器使用技术和依从性都起着关键作用。给药装置之间的差异对患者使用和医护人员指导来说也是一项挑战。
