Personalizing Selection of Inhaled Delivery Systems in COPD

Personalizing Selection of Inhaled Delivery Systems in COPD




$25.00 USD

Provided by the American Thoracic Society
Release Date: September 29, 2023

Program Description

It can be challenging for healthcare professionals (HCPs) to prescribe inhaled therapy for patients with chronic obstructive pulmonary disease (COPD) because of the multiple individual and combinations of inhaled medications available in numerous delivery systems. Guidance on the selection of an inhaled delivery system has received limited attention compared with the emphasis on prescribing the class of the inhaled molecule(s).

Although numerous recommendations and algorithms have been proposed to guide the selection of an inhaled delivery system for patients with COPD, no specific approach has been endorsed in COPD guidelines/strategies or by professional organizations. To provide recommendations for an inhaler selection strategy at initial and follow-up appointments, we examined the impact of patient errors using handheld inhalers on clinical outcomes and performed a focused narrative review to consider patient factors (continuity of the inhaled delivery system, cognitive function, manual function/dexterity, and peak inspiratory flow) when selecting an inhaled delivery system. 

On the basis of these findings, five questions are proposed for HCPs to consider in the initial selection of an inhaler delivery system and three questions to consider at follow-up. We propose that HCPs consider the inhaled medication delivery system as a unit and to match appropriate medication(s) with the unique features of the delivery system to individual patient factors. 

Assessment of inhaler technique and adherence together with patient outcomes/satisfaction at each visit is essential to determine whether the inhaled medication delivery system is providing benefits. Continued and repeated education on device features and correct technique is warranted to optimize efficacy.

Target Audience

Pulmonologists, critical care specialists, translational researchers, and clinicians

Learning Objectives

At the conclusion of this activity, learners should be able to:

  • Instruct COPD patients on correct inhaler technique
  • Describe patient factors that may impair proper inhaler use
  • Identify and address “key” questions to guide initial selection of inhaled delivery system

Course summary

Available Credit:
1.00 Participation
1.00 AMA PRA Category 1 Credit

Credit Expires: October 01, 2025

Format: Journal


The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Type Credit/Points Credit Designation Statement
AMA PRA Category 1 Credit™ 1.00 The American Thoracic Society designates this Journal for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Article Authorship Disclosures (as submitted to the ATS prior to article publication date)

David M.G. Halpin, M.D. (University of Exeter Medical School, Exeter, United Kingdom) reported receipt of payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events for AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Innogen, Novartis, Pfizer, Sanofi, and Menarini; support for attending meetings and/or travel from Menarini; and participation on a Data Safety Monitoring or Advisory Board for Chiesi. 

Donald A. Mahler, M.D. (Geisel School of Medicine, New Hampshire, USA) reported royalties or licenses from Johns Hopkins University Press as author of COPD: Answers to Your Most Pressing Question about Chronic Obstructive Pulmonary Disease; financial or non-financial interest in an educational website for those with COPD and their families;  an honorarium for a lecture sponsorted by Viartis; and participation in Advisory Boards for AstraZeneca, Boehringer Ingelheim, Theravance, Verona, and Viatris.

Off-Label Usage Disclosure


Disclosures of AnnalsATS CME Planners

The Annals of the American Thoracic Society (AnnalsATS) original research, commentaries, reviews, and educational content of interest to clinicians and clinical investigators in pediatric and adult pulmonary and sleep medicine and medical critical care. The scope of the journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists, and the advancement of public health.

The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence supporting the response to the question.

AnnalsATS CME Planners

Margaret M. Hayes, M.D.
Harvard Medical School, Boston MA, USA
Dr. Hayes reported receiving payments as an author for a chapter on heliox for UpToDate. 
Silpa Krefft, M.D., M.P.H. 
Video Editor, AnnalsATS 
University of Colorado, Denver CO, USA 
Dr. Krefft reported providing medicolegal consulting in the area of occupational lung disease.  
Caroline Okorie, M.D., M.P.H.
Stanford University School of Medicine, Stanford CA, USA
Dr. Okorie reported no financial relationships with ineligible companies.


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