Aiding physicians in prescribing the right inhaler

Aiding physicians in prescribing the right inhaler

World-leading Singapore research institute, the Observational Pragmatic Research Institute (OPRI), is the largest contributor to the global understanding of inhalers for lung disease and was recently featured in a systematic review about the various types of inhalers available for asthma and COPD treatment1.

Inhaled therapies are considered one of the most effective strategies in tackling respiratory diseases such as asthma and chronic obstructive pulmonary disorder (COPD). However, healthcare providers may face difficulties in choosing the most appropriate inhaler for their patients due to the sheer number of choices available.

This review therefore aimed to provide evidence-based guidance for physicians to choose the appropriate inhalers for their patients. Factors such as the relative merits of each device, common handling errors, characteristics that may impact optimal drug delivery and patient perceptions of the device were discussed.

OPRI contributed a significant amount of research to this systematic review – roughly 10% of the cited studies were conducted by them. A leading research and development company in Singapore, OPRI has over 12 years of global experience in the field of respiratory research based on real-world evidence. The studies conducted on the effectiveness of inhaler devices for asthma and COPD in a real-world setting, as well as patient adherence to inhalers and common device-handling errors were featured in this review.

The founder of OPRI, Professor David Price, believes that this systematic review could streamline the process of prescribing inhalers.

“This systematic review is one of the most extensive ones conducted on this topic to date. Inhalers are not a one-size-fits-all, and a patient’s adherence to their medication regimen can be greatly affected by the choice of inhaler. Such a collation of the available information on the pros and cons of each inhaler with a focus on treatment outcomes in a real-world setting will certainly simplify the process for physicians,” said Professor Price.

Patient adherence to their inhalers often plays a significant role in why therapies for the management of asthma and COPD don’t work. As highlighted by this review, the Real-life Experience and Accuracy of inhaLer use (REAL) survey conducted by OPRI found that inhaler adherence varied from as much as 58% to 90% across devices. Inhaler device selection therefore has the opportunity to greatly impact treatment outcomes.

Poor inhaler technique is another aspect to be considered. Inhaler technique is often specific to each device, and improper technique can interfere with the delivery of medication to the lungs. While each device is associated with its own set of common handling errors, steps can be taken to minimize them.

“Patients are often unclear about how exactly to handle their inhalers. Each type of inhaler is unique– some require shaking before use, some need better coordination between actuation and inhalation, and so on. Patients need to be properly trained on how to use their inhaler. Otherwise, if they don’t know how to use it properly, they won’t get the full benefit of their medicine,” said Asst Professor Tan Tze Lee, President of the College of Family Physicians, Singapore.

Perhaps the most important factor in choosing an inhaler is the patient’s needs, as this will directly affect both adherence and technique. A more personalized approach to therapy is likely to lead to better treatment outcomes.

However, a gap does exist in the current literature – there are few studies that compare clinical outcomes for the same drug(s) delivered via different devices. Researchers also called for more testing on mobile health technology, such as the use of smartphones, biosensors and automated incentives to reward adherence. Although this growing industry looks promising, there is currently not much information regarding its feasibility, acceptability to patients and sustainability.

This review has the potential to better inform healthcare professionals about inhaler device selection, and thereby, improve treatment outcomes for patients with asthma and COPD. As it provides practical evidence-based considerations, it can help limit the confusion surrounding the prescription of appropriate inhalers and thereby improve the effectiveness of the chosen therapy. As the first of its kind, it can also act as a foundation for future works.

There are several studies that have evaluated the various inhaler devices out there. However, this systematic review answers a question for physicians which the others do not – which inhaler should I prescribe?


  1. Federico Lavorini, Christer Janson, Fulvio Braido, Georgios Stratelis, Anders Løkke. What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape. Therapeutic Advances in Respiratory Disease 2019;13:1-28. [PubMed] [Full Text]