Most aerosol inhalers that are used for treating asthma are equally effective if they are used properly. Which one to use should be based on the ease of use and the cost, according to new guidelines established by the American College of Chest Physicians and the American College of Allergy, Asthma & Immunology (ACAAI).
It is the first time guidelines, which were based on a review of some 60 studies of the efficacy of various aerosol devices, have been offered to doctors and patients involved in asthma treatment.
"There are a lot of devices on the market in all categories, and there was a lot of confusion about which ones to use," explains Myrna B. Dolovich, an engineer and an associate clinical professor of medicine and radiology at McMaster University in Hamilton, Ontario, and the chairwoman of the committee that reviewed these devices.
Since the 1950s and 1960s, people who have asthma have typically been treated with aerosol devices that allow medicine to be inhaled directly into the lungs, thus achieving high drug concentrations in the lungs as well as reducing systemic adverse effects throughout the body.
Hospitals and in-house health settings often use nebulizers, larger machines that effectively deliver medicine to people who experience acute asthma.
The most popular inhaler device, used by approximately 70% of asthma patients, however, is a pressured, metered-dose inhaler (MDI), which lets a patient inhale the medication deep into the lungs via the mouth.
Because it's important to coordinate the spraying of the medicine with inhalation, MDIS are often used with open-tube spacers, which make it easier to do this, especially for younger patients, Dolovich says.
Introduced more recently, and currently gaining in popularity, according to Dolovich, are dry powder inhalers (DPIS). Medicine in the form of a powder is activated when the patient breathes in and does not need to be coordinated with spraying.
The Doctor’s Role
With so many devices to choose from, Dolovich says many doctors rely on "device efficacy"- the stated amount of drug that gets into the lung-when they are selecting treatments for their patients.
However, it's equally important that patients learn proper use of whatever device the doctor prescribes—up to 70% of patients using MDIs use them incorrectly, she says.
"A patient has to know how to use the device and be competent enough to take the medication," Dolovich says.
Dolovich acknowledges that it can be difficult for busy doctors to take the time to train their patients to use the aerosol inhalers, but she says, "You can't hand over a device without checking if it's useful or not."
Further, she says, "Patients should know as well that if they're not getting relief with their medicine they should not hesitate to phone the doctor and say, 'It's not working, and try another device."
Another consideration, she says, should be cost, which necessitates knowing which medicines and devices, if any, are covered by a patient's health insurance policies.
Dr. Meyer Kattan, a professor of pediatrics at Mount Sinai School of Medicine in New York City, agrees with Dolovich that the patient's response to the medicine is key when choosing a device.
"Drug salesmen come around and tell you this drug is better because it has [fewer] side effects or is delivered more efficiently, but these differences are so minute," he says.
"What's important is the patient's competence in using the device and their preference. It's difficult to take medicine every day, and the thing is not to give them medicine they don't like," Kattan adds.