title: Optimising Inhaled Pharmacotherapy for Elderly Patients with Chronic Obstructive Pulmonary Disease: The Importance of Delivery Devices.
abstract: Chronic obstructive pulmonary disease (COPD) is common in older people. Inhaled medications are the mainstay of pharmacological treatment of COPD, and are typically administered by handheld inhalers, such as pressurised metered-dose inhalers and dry powder inhalers, or by nebulisers. For each of the three major categories of aerosol delivery devices, several new inhalers have recently been launched, each with their own particularities, advantages and disadvantages. Consequently, broader availability of new drug-device combinations will increase prescription opportunities. Despite this, however, there is limited guidance available in published guidelines on the choice of inhalers, and still less consideration is given to elderly patients with COPD. The aim of this article is to provide a guide for healthcare professionals on device selection and factors to be considered for effective inhaled drug delivery in elderly COPD patients, including device factors (device type and complexity of use), patient factors (inspiratory capabilities, manual dexterity and hand strength, cognitive ability, co-morbidities) and considerations for healthcare professionals (proper education of patients in device use).
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy. federico.lavorini@unifi.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Lavorini
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Mannini
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Chellini
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Fontana
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016503:Drug Delivery Systems / Q000295:instrumentation*; D058995:Dry Powder Inhalers; D006801:Humans; D036501:Metered Dose Inhalers; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
chemical_list: D000336:Aerosols; D001993:Bronchodilator Agents