Inhaled bronchodilator therapy is relatively inexpensive. For example, eight puffs of salbutamol per day from a metered dose inhaler costs approximately £70 per annum in the UK. This is clearly cost effective if a patient reports significant benefit. Breath-activated inhalers and dry powder inhalers are more expensive than MDIs. Therefore, for patients who can use an MDI effectively, it is the most cost-effective device. However, for patients who cannot use an MDI after careful instruction, these devices may be cost effective if the patient can use them more effectively.
Large volume spacers are a cheap means to enhance the clinical effectiveness of MDI therapy. They are useful and cost-effective for patients with poor inhaler technique. These devices may deliver more aerosol to the lungs than the use of a MDI alone. This is especially useful for patients who require high doses of bronchodilator drugs, thus achieving greater clinical benefit combined with cost-effectiveness. (However, it is important to instruct the patient that only one actuation at a time should be delivered via the large volume spacer, multiple actuations would result in reduced drug delivery to the lungs). For patients who spend most of the day outside their house, these devices are rather large and may be left at home. In these circumstances, a breath-activated device or dry powder device may become more cost-effective if it achieves better symptom control.
Long-acting b2-agonists are considerably more expensive than short-acting b-agonists. However, there is some evidence that the long-acting b-agonists may reduce or delay COPD exacerbations which could make this treatment cost effective .
Nebulized bronchodilator therapy may help some patients with severe COPD to avoid hospital admissions but the effect on admission rates in clinical trials has been inconsistent and may apply to a subgroup of COPD patients that has not yet been defined clearly. If admission rates were reduced for some patients, this would make home nebulizer therapy cost-effective for some COPD patients. Some patients have been given nebulizers in the past without adequate assessment of their inhaled therapy using a range of devices. Such management was clearly not cost effective.
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