New inhalation therapies. The role of the pharmacist in educating patients in correct use of aerosol devices

Abstract

The delivery of aerosolized medication directly to the airways is a mainstay in the emergency treatment and long-term management of chronic obstructive pulmonary disease (COPD), asthma, and other chronic lung diseases in both the adult and pediatric populations. Medication delivery by inhaled aerosols has significant advantages over systemic drug delivery. Drug deposition within the lung is influenced by several factors including particle size, properties of medication to be delivered, type of aerosol generator used, disease state and ventilatory patterns; as well as patient technique, preference and acceptance of the aerosol delivery device. Three common types of aerosol generators are used for inhaled drug delivery: the small-volume nebulizer (SVN), the pressurized metered-dose inhaler (pMDI), and the dry-powder inhaler (DPI). Meta-analysis reports indicate that when used correctly, the amount of actual drug delivered to the airways is comparable with all 3 types of devices. However, both the pMDI and the DPI, while more convenient, are more difficult to use since they both require that specific steps be followed, in precise order, to achieve optimal airway deposition and the desired therapeutic effect. It`s known that poor inhaler technique can markedly reduce the proportion of drug that reaches the lung. Many patients do not use the correct technique when using their inhalers, either because they have never been taught or because they have modified the technique following instruction. Pharmacists can offer advice and education to help improve inhaler technique in various settings and to achieve better therapeutic effect.