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Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion

BACKGROUND: Our aim was to describe: 1) lung deposition and inspiratory flow rate; 2) main characteristics of inhaler devices in chronic obstructive pulmonary disease (COPD). METHODS: A systematic literature review (SLR) was conducted to analyze the features and results of inhaler devices in COPD pa...

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Autores principales: Baloira, Adolfo, Abad, Araceli, Fuster, Antonia, García Rivero, Juan Luis, García-Sidro, Patricia, Márquez-Martín, Eduardo, Palop, Marta, Soler, Néstor, Velasco, J L, González-Torralba, Fernando
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064620/
https://www.ncbi.nlm.nih.gov/pubmed/33907390
http://dx.doi.org/10.2147/COPD.S297980
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author Baloira, Adolfo
Abad, Araceli
Fuster, Antonia
García Rivero, Juan Luis
García-Sidro, Patricia
Márquez-Martín, Eduardo
Palop, Marta
Soler, Néstor
Velasco, J L
González-Torralba, Fernando
author_facet Baloira, Adolfo
Abad, Araceli
Fuster, Antonia
García Rivero, Juan Luis
García-Sidro, Patricia
Márquez-Martín, Eduardo
Palop, Marta
Soler, Néstor
Velasco, J L
González-Torralba, Fernando
author_sort Baloira, Adolfo
collection PubMed
description BACKGROUND: Our aim was to describe: 1) lung deposition and inspiratory flow rate; 2) main characteristics of inhaler devices in chronic obstructive pulmonary disease (COPD). METHODS: A systematic literature review (SLR) was conducted to analyze the features and results of inhaler devices in COPD patients. These devices included pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs), and a soft mist inhaler (SMI). Inclusion and exclusion criteria were established, as well as search strategies (Medline, Embase, and the Cochrane Library up to April 2019). In vitro and in vivo studies were included. Two reviewers selected articles, collected and analyzed data independently. Narrative searches complemented the SLR. We discussed the results of the reviews in a nominal group meeting and agreed on various general principles and recommendations. RESULTS: The SLR included 71 articles, some were of low–moderate quality, and there was great variability regarding populations and outcomes. Lung deposition rates varied across devices: 8%–53% for pMDIs, 7%-69% for DPIs, and 39%–67% for the SMI. The aerosol exit velocity was high with pMDIs (more than 3 m/s), while it is much slower (0.84–0.72 m/s) with the SMI. In general, pMDIs produce large-sized particles (1.22–8 μm), DPIs produce medium-sized particles (1.8–4.8 µm), and 60% of the particles reach an aerodynamic diameter <5 μm with the SMI. All inhalation devices reach central and peripheral lung regions, but the SMI distribution pattern might be better compared with pMDIs. DPIs’ intrinsic resistance is higher than that of pMDIs and SMI, which are relatively similar and low. Depending on the DPI, the minimum flow inspiratory rate required was 30 L/min. pMDIs and SMI did not require a high inspiratory flow rate. CONCLUSION: Lung deposition and inspiratory flow rate are key factors when selecting an inhalation device in COPD patients.
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spelling pubmed-80646202021-04-26 Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion Baloira, Adolfo Abad, Araceli Fuster, Antonia García Rivero, Juan Luis García-Sidro, Patricia Márquez-Martín, Eduardo Palop, Marta Soler, Néstor Velasco, J L González-Torralba, Fernando Int J Chron Obstruct Pulmon Dis Review BACKGROUND: Our aim was to describe: 1) lung deposition and inspiratory flow rate; 2) main characteristics of inhaler devices in chronic obstructive pulmonary disease (COPD). METHODS: A systematic literature review (SLR) was conducted to analyze the features and results of inhaler devices in COPD patients. These devices included pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs), and a soft mist inhaler (SMI). Inclusion and exclusion criteria were established, as well as search strategies (Medline, Embase, and the Cochrane Library up to April 2019). In vitro and in vivo studies were included. Two reviewers selected articles, collected and analyzed data independently. Narrative searches complemented the SLR. We discussed the results of the reviews in a nominal group meeting and agreed on various general principles and recommendations. RESULTS: The SLR included 71 articles, some were of low–moderate quality, and there was great variability regarding populations and outcomes. Lung deposition rates varied across devices: 8%–53% for pMDIs, 7%-69% for DPIs, and 39%–67% for the SMI. The aerosol exit velocity was high with pMDIs (more than 3 m/s), while it is much slower (0.84–0.72 m/s) with the SMI. In general, pMDIs produce large-sized particles (1.22–8 μm), DPIs produce medium-sized particles (1.8–4.8 µm), and 60% of the particles reach an aerodynamic diameter <5 μm with the SMI. All inhalation devices reach central and peripheral lung regions, but the SMI distribution pattern might be better compared with pMDIs. DPIs’ intrinsic resistance is higher than that of pMDIs and SMI, which are relatively similar and low. Depending on the DPI, the minimum flow inspiratory rate required was 30 L/min. pMDIs and SMI did not require a high inspiratory flow rate. CONCLUSION: Lung deposition and inspiratory flow rate are key factors when selecting an inhalation device in COPD patients. Dove 2021-04-19 /pmc/articles/PMC8064620/ /pubmed/33907390 http://dx.doi.org/10.2147/COPD.S297980 Text en © 2021 Baloira et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Review
Baloira, Adolfo
Abad, Araceli
Fuster, Antonia
García Rivero, Juan Luis
García-Sidro, Patricia
Márquez-Martín, Eduardo
Palop, Marta
Soler, Néstor
Velasco, J L
González-Torralba, Fernando
Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion
title Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion
title_full Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion
title_fullStr Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion
title_full_unstemmed Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion
title_short Lung Deposition and Inspiratory Flow Rate in Patients with Chronic Obstructive Pulmonary Disease Using Different Inhalation Devices: A Systematic Literature Review and Expert Opinion
title_sort lung deposition and inspiratory flow rate in patients with chronic obstructive pulmonary disease using different inhalation devices: a systematic literature review and expert opinion
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064620/
https://www.ncbi.nlm.nih.gov/pubmed/33907390
http://dx.doi.org/10.2147/COPD.S297980
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