National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, United Kingdom.
Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Allergy Clin Immunol Pract. 2021 Aug;9(8):3033-3040.e1. doi: 10.1016/j.jaip.2021.04.024. Epub 2021 Apr 24.
Many inhaler devices with varying handling requirements for optimal use are available for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Patients may be prescribed different device types for reliever and maintenance medications, which may lead to confusion and suboptimal device use. We aimed to understand whether simplifying inhaler regimens by employing a single device type in patients who use multiple devices or prescribing a device with which a patient was already experienced could improve clinical and economic outcomes in asthma and COPD management. A targeted literature search was performed and additional articles were identified through hand searching citations within screened publications. A total of 114 articles were included in the final review. Findings suggest that simplifying inhaler regimens by applying the same type of inhaler for concomitant inhaled medications over time minimizes device misuse, leading to improved clinical outcomes and reduced health care use in patients with asthma or COPD. Physicians should consider a patient's suitability for a device and training needs when prescribing an inhaled medication and before changing the medication type or dose, especially when suboptimal treatment outcomes are observed. Further research is required to determine whether consistent use of the same device type is associated with better treatment adherence and persistence in patients with asthma or COPD. Nevertheless, this literature review identified clinical benefits and reduced health care use with simplified inhaler regimens.
许多具有不同操作要求的吸入器设备可用于治疗哮喘和慢性阻塞性肺疾病（COPD）。患者可能会被开具不同类型的设备用于缓解和维持药物治疗，这可能导致混淆和设备使用不当。我们旨在了解在使用多种设备的患者中通过使用单一设备类型或为已经熟悉某种设备的患者开具该设备，是否可以改善哮喘和 COPD 管理中的临床和经济结局。进行了针对性的文献检索，并通过在手边筛查出版物的参考文献中进行手动搜索，确定了其他文章。最终综述共纳入了 114 篇文章。研究结果表明，随着时间的推移，通过为同时使用的吸入药物应用相同类型的吸入器来简化吸入器方案，可以最大程度地减少设备误用，从而改善哮喘或 COPD 患者的临床结局并减少医疗保健的使用。医生在开具吸入药物以及改变药物类型或剂量之前，应考虑患者对设备的适用性和培训需求，特别是在观察到治疗效果不佳时。还需要进一步研究以确定在哮喘或 COPD 患者中，是否一致使用相同类型的设备与更好的治疗依从性和持久性相关。然而，本次文献综述确定了简化吸入器方案具有临床益处，并减少了医疗保健的使用。
