Most patients with COPD are best treated with a hand-held device such as a metered dose inhaler or dry powder inhaler. There is not much clinical differ ence between the bronchodilator response achieved by different devices. The most important factor is to choose a device that the patient is able to use. For many COPD patients (especially the elderly), a breath-activated MDI or an MDI with spacer may be the easiest device for the patient to use.
Dry powder devices such as Diskhaler, Accuhaler, Clickhaler or Turbuhaler have all been used in COPD patients but there are few trials comparing the advantages and disadvantages of different hand-held inhaler devices in patients with COPD. For patients with extremely low inspiratory flow, an MDI with large volume spacer may achieve better lung delivery than a dry powder device or a breath-activated inhaler. For most patients, the key factor is the patient's ability to use the inhaler device.
A recent meta-analysis of trials of bronchodilator therapy using different hand-held inhaler devices showed that here was no important difference in clinical outcomes between metered dose inhalers, breath-activated inhalers or dry powder devices . This meta-analysis involved patients with asthma but it is likely that these findings would apply equally to COPD patients (provided they can use the device which is prescribed for them).
Most bronchodilator studies with spacer devices have used large (750 mL) spacer devices such as the Volumatic or Nebuhaler device. However, these devices are rather large and many patients prefer a smaller device such as 'Aerochamber' although its use has not been as well validated in COPD as the larger devices. The smaller devices may not deliver as much aerosol to the lung, especially if used with the older CFC-containing inhalers which have a high spray velocity.
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