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Table 5 Devices for delivery of combination bronchodilators

From: Combination bronchodilator therapy in the management of chronic obstructive pulmonary disease

Type of delivery device Description Advantages Disadvantages Combination products in development
pMDI Drug is dissolved in propellant (generally HFA). When activated, a valve system releases a metered volume of propellant containing the medication Can be more cost-effective than DPIs [84] Can be difficult to synchronize actuation with inhalation [89, 90] Pearl inhaler for glycopyrrolate + formoterol (Pearl Therapeutics) [86]
High fine-particle fraction, leading to better peripheral lung deposition Evidence suggests fewer patients use pMDIs correctly without teaching [84]
Breath-actuated DPIs require no hand-lung coordination  
DPI Drug is delivered in powder form on inspiration by the patient; de-aggregation of the powder and generation of the aerosol provided by the patient’s inspiratory effort Activated by inhalation, avoiding synchronization issues [84] Can be more expensive vs MDIs [84] Breezhaler® for indacaterol + glycopyrronium (single-dose, Novartis) [87]
Evidence suggests more patients have an accurate inhaler technique with DPIs without teaching [84] Errors in inhaler technique can still occur [92] Ellipta® Vilanterol (single-dose, GSK)
   Pressair® for aclidinium (multi-dose, Almirall) [88]
Soft Mist™ Inhaler Delivers a metered dose of medication as a slow-moving “soft mist” through a unique nozzle system, which should lead to improved lung and reduced oropharyngeal deposition vs other types of inhaler [85, 93] Drug delivery is not dependent on patient’s inspiratory capacity or inspiratory effort, allowing consistent deposition regardless of lung function [85] and higher lung deposition in patients with poor inhaler technique [91] Less clinical experience with this device; more safety data are required Respimat® for tiotropium + olodaterol (Boehringer Ingelheim) [85]
  1. pMDI = pressurized metered dose inhaler; HFA = hydrofluoroalkane; DPI = dry powder inhaler.