title: Guidance on handheld inhalers in asthma and COPD guidelines.
abstract: BACKGROUND
  Inhaled therapy is the cornerstone of pharmacotherapy in patients with asthma and chronic obstructive pulmonary disease (COPD). Appropriate inhalation device selection is as important as drug choice but device-specific guidance appears to be lacking.
  
  
  METHODS
  To quantify the level of inhalation-device recommendations in clinical guidelines, a review was conducted by hand-searching national and international asthma and COPD guidelines (Global Initiative for Asthma [GINA] and Global initiative for chronic Obstructive Lung Disease [GOLD] guidelines) and an international guideline on device selection (the American College of Chest Physicians/American College of Asthma, Allergy, and Immunology [ACCP/ACAAI]). For each guideline, the number of pages, tables/figures and references relating to inhalation devices was identified.
  
  
  RESULTS
  GINA and GOLD guidelines contain very little inhalation device-specific guidance beyond recommendations for demonstrating and testing correct inhalation technique: <2% of pages or references and <3% of tables/figures are dedicated to devices. Device-related content in the ACCP/ACAAI device selection guideline was considerably higher with 54% of pages, 88% of tables/figures and 82% of references, respectively. Results in national guidelines reflect those on international guidelines.
  
  
  CONCLUSIONS
  These results indicate that there is a considerable lack of clear and specific guidance regarding inhalation devices in current asthma/COPD guidelines. More robust studies on the impact of inhalation devices are needed to increase the number of evidence statements and recommendations regarding inhalation devices.
authors.affiliation: Department of Pulmonary Diseases (454), Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: R.Dekhuijzen@LONG.umcn.nl.
authors.forename: P N Richard
authors.initials: PN
authors.lastname: Dekhuijzen
authors.affiliation: Department of Respiratory Medicine, Lund University Hospital, SE-22185 Lund, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Bjermer
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Lavorini
authors.affiliation: Service de Pneumologie, Saint-Pierre University Hospital Brussels, 322 rue Haute, B-1000 Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ninane
authors.affiliation: University of Bordeaux, INSERM U657, 33076 Bordeaux Cedex, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Molimard
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, AB25 2AY Scotland, UK.
authors.forename: John
authors.initials: J
authors.lastname: Haughney
mesh_terms: D000280:Administration, Inhalation; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D004867:Equipment Design; D006801:Humans; D009330:Nebulizers and Vaporizers / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D019141:Respiratory System Agents / Q000008:administration & dosage*
chemical_list: D001993:Bronchodilator Agents; D019141:Respiratory System Agents
keywords: Asthma; Chronic obstructive pulmonary disease; Dry powder inhalers; Guidelines; Pressurised metered-dose inhalers