Department of Family Medicine, UCLA School of Medicine, Los Angeles, CA 90077, USA.
Postgrad Med. 2010 Mar;122(2):83-93. doi: 10.3810/pgm.2010.03.2125.
Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation resulting from emphysema and chronic bronchitis. Inhaled therapy is the major therapeutic approach for treating COPD. Multiple inhaler medications are available in the United States and are delivered by a variety of different devices: metered-dose inhalers, dry powdered inhalers, and nebulizers. Each inhaler device has unique requirements for use that must be correctly performed by the patient for successful drug delivery. Patients with COPD represent a medically diverse population, with each patient having distinct characteristics, such as lung function, comorbidities, cognitive functions, hand strength, and lifestyle. These characteristics impact the patient's ability to properly use specific inhaler devices and therefore affect adherence to therapy, therapeutic outcomes, and quality of life. It is estimated that between 28% to 68% of patients do not use metered-dose inhalers or dry powder inhalers correctly. Worsening symptoms or increased frequency of exacerbations may not always indicate disease progression but may indicate a patient's inability to use their inhaler device properly. This review discusses the patient- and device-specific factors to be considered when choosing an inhaled therapy, which will be concordant with the patient's medical needs, preferences, and lifestyle. The review also considers how the ideas underlying the patient-centered medical home model can be incorporated into the choice and use of inhaler device for a given patient with COPD to improve treatment outcomes.
慢性阻塞性肺疾病（COPD）是一种渐进性疾病，其特征是气流受限，由肺气肿和慢性支气管炎引起。吸入疗法是治疗 COPD 的主要治疗方法。在美国有多种吸入器药物可供选择，并通过各种不同的设备进行输送：计量吸入器、干粉吸入器和雾化器。每种吸入器设备都有其独特的使用要求，患者必须正确操作才能成功输送药物。COPD 患者代表了一个医学多样化的人群，每个患者都有独特的特征，如肺功能、合并症、认知功能、手部力量和生活方式。这些特征会影响患者正确使用特定吸入器设备的能力，从而影响治疗依从性、治疗效果和生活质量。据估计，有 28%至 68%的患者没有正确使用计量吸入器或干粉吸入器。症状恶化或加重的频率增加并不总是表明疾病进展，而可能表明患者无法正确使用他们的吸入器设备。本文综述讨论了在选择吸入治疗时需要考虑的患者和设备特定因素，这将与患者的医疗需求、偏好和生活方式相一致。本文还考虑了如何将以患者为中心的医疗之家模式的基本理念纳入 COPD 患者吸入器设备的选择和使用中，以改善治疗效果。
