T he Brussels Declaration, published in the European Respiratory Journal in 2008 [1], recognises the high prevalence of patients with poorly controlled asthma and calls for changes in asthma management across Europe. Prescribing an appropriate inhaler device for asthma, a device that the patient accepts and can handle correctly, is one key element in this process. Inhaler mishandling is very co...

OBJECTIVE To systematically review the risk of mortality associated with long term use of tiotropium delivered using a mist inhaler for symptomatic improvement in chronic obstructive pulmonary disease. DATA SOURCES Medline, Embase, the pharmaceutical company clinical trials register, the US Food and Drug Administration website, and ClinicalTrials.gov for randomised controlled trials from ince...

Inhaled glucocorticoids such as beclomethasone dipropionate, which are used in the treatment of asthma, may be associated with systemic adverse effects. To determine whether any systemic absorption following the inhalation of beclomethasone was a result of drug being absorbed from the lung (inhaled fraction) or the gastrointestinal tract (swallowed fraction), we studied normal subjects after th...

Asthma and chronic obstructive pulmonary disease (COPD) patients are required to inhale forcefully and deeply to receive medication when using a dry powder inhaler (DPI). There is a clinical need to objectively monitor the inhalation flow profile of DPIs in order to remotely monitor patient inhalation technique. Audio-based methods have been previously employed to accurately estimate flow param...

BACKGROUND There are several nicotine replacement products on the market, and physicians are likely to be asked with increasing frequency about which of these products their patients should use. OBJECTIVE To provide a basis for rational advice by comparing nicotine polacrilex (gum), a transdermal patch, nasal spray, and an inhaler. DESIGN Randomized trial with assessments at the quit date a...

BACKGROUND The percentage of patients inhaling their medication effectively varies widely, according to methods of assessment and inhalers used. This study was carried out to assess differences among four types of inhalers using inhaler-specific checklists. METHODS Inhalation technique was evaluated in adult patients with chronic obstructive pulmonary disease (COPD). Inhalers investigated wer...

How big a problem is inhaler technique and how important is it? In this issue of the European Respiratory Journal we are presented with a “real-life” study exploring the inhaler technique of almost 3000 patients with chronic obstructive pulmonary disease (COPD) and the relationship between inhaler device handling and disease control. This observational, cross-sectional study, conducted by MOLIM...

BACKGROUND Multi-dose dry-powder inhalers are perceived as being easier for patients to use than conventional pressurized aerosol inhalers; however, no study has determined whether patients handle such devices adequately and whether there is a need for patient education in this area. METHOD We used trained observers to assess the handling of a specific multi-dose dry powder inhaler (Turbuhale...

The performance of dry powder aerosols for the delivery of drugs to the lungs has been studied extensively in the last decade. The focus for different research groups has been on aspects of the powder formulation, which relate to solid state, surface and interfacial chemistry, bulk properties (static and dynamic) and measures of performance. The nature of studies in this field, tend to be compl...

OBJECTIVE To examine the influence of inhalation device (Autohaler versus metered dose inhaler) and patients' subjective opinion towards the different devices, as well as daily frequency and duration of treatment on medication compliance. DESIGN Prospective study measuring compliance in the same patients of the Autohaler twice daily with the metered dose inhaler twice daily, as well the Autoh...