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What’s the best treatment match for your COPD patient?

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by Nurse Beth Nurse Beth, MSN (Columnist)

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

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What’s the best treatment match for your COPD patient?

Approximately 15.7 million Americans have been diagnosed with chronic obstructive pulmonary disease (COPD), and each one of them requires an individualized approach.1,2 It’s important to understand the different options when selecting an inhalation device for this complex patient population.

On top of their breathing troubles, many patients may have other issues, such as cognitive and physical limitations.3,4 Remembering and following multiple steps, and coordinating a sequence of exhalations and inhalations, are some of the challenges these patients may face when operating their devices. In addition, maintaining an active lifestyle can be important for many patients struggling with COPD, so equipment and/or treatments with prolonged administration duration can be a challenge.5

A review of the different delivery options for COPD could help healthcare professionals choose the appropriate device for their patients.6 For many patients with COPD, adherence can be a major problem. Healthcare professionals can strive to mitigate adherence issues by considering their patients’ abilities and preferences and matching them to the appropriate inhalation device.6,7 Surveys suggest that there are opportunities for healthcare professionals to better connect with patients in terms of device training and technique. Approximately 25% of patients do not receive instructions for using their inhalation device, and 69% of patients report that their healthcare professionals have never watched them take their medication.8

COPD delivery options

COPD-ArticleB-Icon1.png.360c33c0647b7c1e98f928df4c73b80f.pngMetered-dose inhalers (MDIs)4,7,9-11
  • Compressed chemical propellant delivers medication in aerosol form
  • Require coordination of breathing and actuation of device
  • No drug preparation necessary, though shaking the device is required
  • Administered in 1 or 2 breaths
COPD-ArticleB-Icon2.png.5fee995da4de628a668d034ee7d47c3d.pngSlow-mist inhalers (SMIs)4,12,13
  • Use a Spring mechanism to create a mist
  • Breath coordination is required
  • Multiple steps for setup
  • Administered in 1 or 2 breaths
COPD-ArticleB-Icon3.png.a5274e3603d54521b12f11c0c87bab63.pngDry-powder inhalers (DPIs)9,10,14-17
  • Breath actuated
  • Proper breathing technique is required
  • Minimal setup; patient may need to load capsule
  • Administered in 1 or 2 breaths
COPD-ArticleB-Icon4.png.9133f6fd5f7331c4d4fdb753861c6da6.pngJet nebulizers4,9,18
  • High-velocity air stream creates breathable mist
  • Natural breathing administration
  • Multiple steps for setup and maintenance
  • Administration can take up to 20 minutes
COPD-ArticleB-Icon5.png.68a20c39cae05506295c5c11e15eac50.pngVibrating membrane or mesh nebulizers4,13
  • Vibrating perforated material creates breathable mist
  • Natural breathing administration
  • Multiple steps for setup and maintenance
  • Administration can take less than 5 minutes

It is important to train patients on how to use their devices upon initiation and to regularly reassess and refresh them on proper technique. Knowing the pros and cons of different delivery options can help optimize treatments and deliver the best results for patients. When necessary, healthcare professionals should consider and advocate for alternative device options for appropriate patients.6


1. Wheaton AG, Cunningham, TJ, Ford ES, Croft JB; Centers for Disease Control and Prevention. Employment and activity limitations among adults with chronic obstructive pulmonary disease—United States, 2013. MMWR Morb Mortal Wkly Rep. 2015;64(11):289-295.

2. Patel M, Steinberg K, Suarez-Barcelo M, et al. Chronic obstructive pulmonary disease in post-acute/long-term care settings: seizing opportunities to individualize treatment and device selection. J Am Med Dir Assoc. 2017:18(6):S53. e17-S53.e22.

3. Zarowitz BJ O’Shea T. Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment. J Manag Care Pharm. 2012;18(8):598-606.

4. Dhand R, Dolovich M, Chipps B, Myers TR, Restrepo R, Farrar JR. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9(1):58-72.

5. Amultiari HJ, Mussa CC, Lambert CT, Vines DL, Strickland SL. Perspectives from COPD subjects on portable longterm oxygen therapy devices. Respiratory Care. 2018;63(11):1321-1330.

6. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2020:1-125.

7. Restrepo RD, Alvarez MT, Wittnebel LD, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-384.

8. Cho-Reyes S, Celli BR, Dembek C, Yeh K, Navaie M. Inhalation technique errors with metered-dose inhalers among patients with obstructive lung diseases: a systematic review and meta-analysis of U.S. studies. Chronic Obstr Pulm Dis. 2019;6(3):267-280.

9. Dolovich MB, Ahrens RC, Hess Dr, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. CHEST. 2005;127(1):335-371.

10. Pelegrin GM. Asthma inhalers? What you should know. Pharm Times. https://www.pharmacytimes.com/publications/ issue/2003/2003-05/2003-05-7182. Published May 1, 2018. Accessed March 30, 2020.

11. AZMACORT [prescribing information]. Kos Pharmaceuticals, Inc. 2007. 12. Anderson P. Use of Respimat® Soft MistTM Inhaler in COPD patients. Int J Chron Obstruct Pulmon Dis. 2006;1(3):251- 259.

13. Tashkin DP. A review of nebulized drug delivery in COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:2585-2596.

14. Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593-604.

15. Al-Showair RA, Tarsin WY, Assi KH, Pearson SB, Chrystyn H. Can all patients with COPD use the correct inhalation flow with all inhalers and does training help? Respir Med. 2007;101(11):2395-2401.

16. ADVAIR DISKUS [prescribing information]. GlaxoSmithKline: 2019.

17. SPRIVIA RESPIMAT [prescribing information]. Boehringer Ingelheim International GmbH: 2019.

18. Knoch M, Keller M. The customised electronic nebuliser: a new category of liquid aerosol drug delivery systems. Expert Opin Drug Deliv. 2005;2(2):377-390.

SUNOVION is a registered trademark of Sumitomo Dainippon Pharma Co., Ltd. Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd. ©2020 Sunovion Pharmaceuticals Inc. All rights reserved. 4/20 RESP-US-00039-20

This is a sponsored article brought to you by allnurses.com in conjunction with the advertiser. The views expressed in this article are those of the advertiser and do not necessarily reflect allnurses.com, its parent company, or its staff.

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.

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