Dahl Ronald, Kaplan Alan
Odense University Hospital, Odense, Denmark.
Family Physician Airways Group of Canada, Richmond Hill, ON, Canada.
BMC Pulm Med. 2016 Oct 11;16(1):135. doi: 10.1186/s12890-016-0291-4.
In many countries worldwide, the long-acting anticholinergic drug tiotropium is available as a dry powder formulation delivered by means of the HandiHaler® inhalation device and as an aqueous solution delivered via the Respimat® Soft Mist™ Inhaler. Tiotropium HandiHaler® is a single-dose, dry powder, breath-actuated inhaler that provides delivered doses and lung deposition of tiotropium that are, over a wide range, not influenced by the severity of chronic obstructive pulmonary disease (COPD). Tiotropium Respimat® is a propellant-free, multi-dose inhaler that delivers a metered dose of medication as a fine, slow-moving, long-lasting soft mist, independently of patient inspiratory effort. The high fine-particle fraction of droplets produced by the Respimat® inhaler optimizes the efficiency of drug delivery to the lungs.
To help inform the choice of tiotropium inhaler for prescribers and patients, this systematic review summarizes the available pharmacokinetic, efficacy and safety data from comparative studies of tiotropium Respimat® and tiotropium HandiHaler® in COPD, focusing on the licensed once-daily doses of 5 and 18 μg, respectively. Data sources reviewed include publications and abstracts identified from database searches.
Published evidence from comparative studies suggests that tiotropium Respimat® 5 μg and tiotropium HandiHaler® 18 μg provide similar clinical outcomes in patients with COPD.
The findings indicate that physicians can base their decision about an inhaler for tiotropium on factors other than efficacy or safety. These could be patient preference for a particular inhaler, ease of use and the efficiency of drug delivery, with the aim of optimizing adherence and clinical outcomes with long-term tiotropium maintenance therapy.
在全球许多国家，长效抗胆碱能药物噻托溴铵有通过HandiHaler®吸入装置递送的干粉制剂，以及通过Respimat®软雾吸入器递送的水溶液两种剂型。噻托溴铵HandiHaler®是一种单剂量、干粉、呼吸驱动的吸入器，其提供的噻托溴铵递送剂量和肺部沉积量在很大范围内不受慢性阻塞性肺疾病（COPD）严重程度的影响。噻托溴铵Respimat®是一种不含推进剂的多剂量吸入器，可独立于患者吸气努力，将定量药物作为精细、缓慢移动、持久的软雾递送。Respimat®吸入器产生的高细颗粒分数液滴优化了药物递送至肺部的效率。
为帮助医生和患者选择噻托溴铵吸入器，本系统评价总结了噻托溴铵Respimat®和噻托溴铵HandiHaler®在COPD中比较研究的现有药代动力学、疗效和安全性数据，重点关注分别为5μg和18μg的许可每日一次剂量。审查的数据来源包括从数据库搜索中识别的出版物和摘要。
比较研究的已发表证据表明，5μg噻托溴铵Respimat®和18μg噻托溴铵HandiHaler®在COPD患者中提供相似的临床结果。
研究结果表明，医生在选择噻托溴铵吸入器时，可基于疗效或安全性以外的因素做出决定。这些因素可以是患者对特定吸入器的偏好、易用性和药物递送效率，目的是通过长期噻托溴铵维持治疗优化依从性和临床结果。
