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Customer is always right: optimising inhaler design to fit patient preferences in obstructive lung disease
  1. Andrew Gangemi,
  2. Victor Kim,
  3. Gerard Criner
  1. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Andrew Gangemi, Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; andrew.gangemi{at}

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Patient confidence in their inhaler regimen is essential in the management of asthma and COPD. Inhaler misuse is associated with poorer symptom control, more frequent use of oral corticosteroids and antibiotics for rescue, and more frequent hospitalisations in both COPD and asthma.1 Device designs have expanded to allow for ease of use; each device has its benefits and drawbacks. Metered dose inhalers (MDIs) are pressurised and therefore less reliant on inspiratory effort. Breath-actuated MDIs, while more expensive and limited in range of agents, help to minimise timing errors. Dry powder inhalers also require less coordination but may be less effective with higher degrees of airflow obstruction. Soft mist inhalers offer extremely low resistance, improved delivery to the deeper respiratory tract, and less deposition in the oropharynx and upper trachea. There is currently only one soft mist device approved by the FDA, which limits the number of available agents through this delivery method.2 Education during initiation and follow-up is key for ensuring effective drug delivery, as technical errors are as frequent as 30% during each …

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  • Contributors AG took lead role in preparation and literature review for this editorial. VK and GC provided guidance and oversight.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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