title: New developments in inhaler devices within pharmaceutical companies: A systematic review of the impact on clinical outcomes and patient preferences.
abstract: BACKGROUND
  Pharmaceutical companies offer an increasing number of inhaler devices, whether or not together with new substances, for maintenance treatment of patients with COPD or asthma. However, well-designed studies to support these developments are scarce.
  
  
  OBJECTIVE
  The aim of this research was to evaluate how far new developments of inhaler devices are scientifically supported and translate into improvements of patient preferences and/or clinical outcomes.
  
  
  METHODS
  A systematic literature review was performed to retrieve randomised controlled trials in patients with COPD or asthma that studied the in-company evolution of inhaler devices. Results were tabulated and discussed.
  
  
  RESULTS
  A total of 30 studies were found comparing Respimat(®) vs. HandiHaler(®), Diskus(®)(Accuhaler(®)) vs. Diskhaler(®)(Rotadisk(®)) or pMDI, Ellipta(®) vs. Diskus(®)(Accuhaler(®)), Nexthaler(®) vs. pMDI, or Breezhaler(®) vs. Aerolizer(®). These studies show that developments of inhaler devices may improve patient satisfaction but do not lead to demonstrable improvements in clinical efficacy. Current changes of devices are most commonly parallelled by changes in administration frequency towards once daily treatment. The only well-documented effect was found for the Respimat(®) Soft Mist™ Inhaler, which realises a more than 3-fold lowering of the once-daily tiotropium dose through increased performance of the inhaler device. There are however, no data on clinical efficacy or safety comparing the two devices at the same dosage.
  
  
  CONCLUSIONS
  Future developments of inhaler devices should all require well-designed studies to demonstrate patient benefit.
authors.affiliation: Department of Respiratory Medicine, University Hospital Saint-Pierre, Brussels, Belgium. Electronic address: Vincent_NINANE@stpierre-bru.be.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ninane
authors.affiliation: Department of General Practice, Free University of Brussels, Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Vandevoorde
authors.affiliation: Department of Respiratory Medicine, University Hospital Sart-Tilman, University of Liège, Liège, Belgium.
authors.forename: Didier
authors.initials: D
authors.lastname: Cataldo
authors.affiliation: Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Derom
authors.affiliation: Department of Respiratory Medicine, University Hospitals Saint-Luc, Brussels, Belgium.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liistro
authors.affiliation: Department of Respiratory Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
authors.forename: Evert
authors.initials: E
authors.lastname: Munghen
authors.affiliation: Department of Respiratory Medicine, University Hospital Vésale, Montigny-le-Tilleul, Belgium.
authors.forename: Rudi
authors.initials: R
authors.lastname: Peché
authors.affiliation: Department of Respiratory Medicine, University Hospital Luxembourg, Luxembourg.
authors.forename: Marc
authors.initials: M
authors.lastname: Schlesser
authors.affiliation: Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Verleden
authors.affiliation: Respiratory Division, University Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Vincken
mesh_terms: D000280:Administration, Inhalation; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004345:Drug Industry; D058995:Dry Powder Inhalers; D004867:Equipment Design; D006801:Humans; D009330:Nebulizers and Vaporizers / Q000639:trends*; D057240:Patient Preference; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents
keywords: Asthma; Chronic obstructive pulmonary disease; Dry powder inhaler; Inhalation therapy; Inhaler device; Respimat; Systematic review