8/1/2023 0 Comments Lama laba sama saba2, 22 Further, during exacerbations and in recovery, many COPD patients have decreased peak inspiratory flow rate (PIFR) and are unable to use handheld inhalers effectively. ![]() 1, 2 However, physical and/or cognitive symptoms that are common in some COPD patients (eg, the elderly 19, 20) could interfere with the proper administration of inhaled therapies via handheld inhalers, 21 resulting in insufficient dosing and jeopardizing health outcomes, reducing quality of life, and further adding to the economic burden of COPD. To reduce symptoms, frequency, and severity of COPD exacerbations and improve health status and exercise tolerance, the GOLD strategy document 2 recommends that bronchodilators are the cornerstone of pharmacotherapy for COPD in the majority of patients. 17 In 2010, the cost of COPD in the US was projected to be ~$49.9 billion, which included ~$20 billion in indirect costs (eg, loss of work productivity and earnings) and $30 billion in direct health care expenditures (eg, prescription medicines and emergency department visits). While >12 million people in the US are known to have COPD, it is estimated that up to 24 million may have impaired lung function and undiagnosed disease. 2, 13, 14 The global social and economic burden of COPD is projected to increase, due to aging populations and the continued use of tobacco and exposure to biomass fuels, 15, 16 underscoring the need for more effective management of this disease. 2, 11, 12 COPD represents a global health problem, is ranked as the fourth leading cause of death in the world, and significantly affects patient quality of life. This article reviews recent innovations in nebulized drug delivery and the important role of nebulized therapy in the treatment of COPD.ĬOPD, a common preventable and treatable disease, is characterized by progressive persistent airflow obstruction that is associated with an enhanced inflammatory response to noxious particles or gases in the lung and airways. 9, 10 Moreover, several of the emerging medications for COPD (both marketed and under development) utilize nebulizer technology. In addition, both patients and their caregivers are becoming increasingly satisfied with nebulized drug delivery and have reported benefits in symptom relief, ease of use, and improved quality of life when using this system. 2 Further, GOLD recommends evaluating the benefits of nebulizer treatment symptomatically and continuing treatment as long as similar benefits are not achievable by simpler, cheaper, and more portable alternatives. ![]() Although DPIs and pMDIs are the most commonly used devices 7, 8 and are recommended for long-term treatment in the vast majority of patients, 2 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document recommends nebulizers for specific patient populations (eg, patients with very low inspiratory flow rates) in whom nebulizer treatment may provide more benefits than DPIs or MDIs. 1, 2 Four commonly prescribed inhalation devices, pressurized metered dose inhalers (pMDIs), dry powder inhalers (DPIs), slow mist inhalers (SMIs), and nebulizers, have similar efficacies in patients with COPD, 3 – 6 provided they are used appropriately. Inhaled pharmacologic therapy is a cornerstone of treatment for patients with COPD. This article reviews recent innovations in nebulized drug delivery and the important role of nebulized therapy in the treatment of COPD. As more drugs become available in solution formulations, patients with COPD and their caregivers are becoming increasingly satisfied with nebulized drug delivery, which provides benefits similar to drugs delivered by handheld inhalers in both symptom relief and improved quality of life. ![]() Dry powder inhalers and pressurized metered dose inhalers are the most commonly used drug delivery devices, but they may be inadequate in various clinical scenarios (eg, the elderly, the cognitively impaired, and hospitalized patients). Bronchodilators (β 2-agonists and antimuscarinics) are the mainstay of pharmacologic therapy in patients with COPD, with long-acting agents recommended for patients with moderate to severe symptoms or those who are at a higher risk for COPD exacerbations. ![]() Current guidelines recommend inhaled pharmacologic therapy as the preferred route of administration for treating COPD.
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