FIDEPOC: Consensus on Inspiratory Flow and Lung Deposition as Key Decision Factors in COPD Inhaled Therapy

Area of Science:

• Pulmonary Medicine
• Pharmacology
• Medical Devices

Background:

• Chronic Obstructive Pulmonary Disease (COPD) management relies heavily on inhaled bronchodilators.
• Optimal inhaled therapy requires consideration of patient-specific inspiratory flow and drug deposition in the lungs.
• The interplay between inspiratory parameters, patient characteristics, and inhaler suitability for COPD remains incompletely understood.

Purpose of the Study:

• To achieve expert consensus on the significance of inspiratory flow and lung deposition in COPD inhaled therapy selection.
• To identify key decision-making factors for choosing appropriate inhalation devices for COPD patients.

Main Methods:

• A two-round Delphi Panel methodology was employed.
• Fifty-seven Spanish pulmonologists participated, evaluating 38 consensus statements.
• Consensus levels for each statement regarding inhaled therapy parameters were measured.

Main Results:

• High consensus was achieved on several key items.
• Inspiratory flow and capacity are critical for selecting and ensuring the suitability of inhalation devices.
• Outflow velocity and particle size influence lung deposition; active devices (pMDI, SMI) are preferred for low inspiratory flow patients.
• Dry powder inhaler (DPI) use requires re-evaluation in severe COPD obstruction and exacerbations.

Conclusions:

• Inspiratory flow and lung deposition are highly relevant for selecting inhalation devices in COPD.
• Soft Mist Inhaler (SMI) devices demonstrate convenience for patients with reduced inspiratory flow.
• Current COPD guidelines offer limited information on specific inhalation device features.