Factors affecting inhaler device selection and solutions

Selection and usage considerationsMeasures to address these
Patient-related factors• Understanding of need for inhaler device/medication(break/)• Age(break/)• Coordination(break/)• Manual dexterity(break/)• PIF rates(break/)• Cognitive impairment(break/)• Comorbidities(break/)• Patient preference• Provide adequate training for all patients(break/)• Older patients may need additional time for training(break/)• Consider using BA devices or spacers if coordination/manual dexterity is poor(break/)• DPIs usually require good inspiratory flow; consider other devices if PIF is very low(break/)• Consider easier-to-use/passive inhalation devices with cognitive impairment (eg, nebulizers)(break/)• Where possible, combine multiple medications in one device, or maintain consistency of device types across medications(break/)• Take patient preference/finances into account
System/health care professional factors• Knowledge/training of health care professional(break/)• Device availability(break/)• Cost (including out-of-pocket cost to patient)• Provide adequate training to health care professionals as well as patients(break/)• Ensure device is available to patient(break/)• Evaluate cost vs clinical benefit
  • Abbreviations: BA, breath-actuated; DPI, dry powder inhaler; PIF, peak inspiratory flow.