We know that there is an increasing prevalence of asthma and COPD worldwide, leading to increased inhaler use. Chapter 3 of the British National Formulary1 has grown significantly over the years in terms of the number of inhaler options. There are currently, in the UK, more than 20 different inhaler devices available, with over 118 possible combinations of drug and device to prescribe. The inhaler market has become very crowded, with patents expiring for some of the most widely used inhaled drugs. Several analogues of branded inhaled corticosteroids/long-acting β2-adrenoceptor agonists (ICS/LABA) fixed-dose combinations have entered the market with different inhaler devices, and longer-acting ‘me-too’ formulations have appeared. Incorrect or suboptimal patient technique in using inhalers has led to yet further inhaler devices being developed, and combination/triple inhalers have been launched to support patients. Current clinical evidence suggests that, although existing inhaled therapy has the potential to control disease in most patients with asthma, control is often not achieved in practice.2 Suboptimal inhaler technique is the prominent reason for the lack of efficacy; no matter how good a drug or device is, it cannot be effective if the drug does not reach the targeted airways. Inhaler errors are associated with worsening in disease control, increased rate of exacerbations, increased healthcare resource consumption, and consequently increased healthcare expenditure.3–5 A recent systematic literature review and meta-analysis found that incorrect inhaler technique is common across devices, with up to 100% of patients demonstrating at least one error. Moreover, up to 92% of patients experience critical errors, that is, one that may impact the effectiveness of the delivered drug.6 While Chrystyn et al ’s3 team found high critical error rates reported across all devices, their meta-analysis and systematic review highlighted significant gaps in knowledge regarding different inhalers and associated error …

中文翻译：

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吸入器：换还是不换？就是那个问题

我们知道，全球范围内哮喘和 COPD 的患病率越来越高，导致吸入器的使用增加。多年来，英国国家处方集1的第 3 章在吸入器选项的数量方面显着增加。目前，在英国，有超过 20 种不同的吸入器设备可供使用，可开出超过 118 种可能的药物和设备组合。吸入器市场变得非常拥挤，一些最广泛使用的吸入药物的专利即将到期。多种品牌吸入性皮质类固醇/长效 β2-肾上腺素能受体激动剂 (ICS/LABA) 固定剂量组合的类似物已通过不同的吸入装置进入市场，并且出现了长效“me-too”制剂。使用吸入器时不正确或次优的患者技术导致了进一步的吸入器设备的开发，和组合/三重吸入器已推出以支持患者。目前的临床证据表明，虽然现有的吸入疗法有可能控制大多数哮喘患者的疾病，但在实践中往往无法控制。2 吸入技术欠佳是缺乏疗效的主要原因；再好的药物或器械，如果没有到达目标气道，就无法发挥作用。吸入器错误与疾病控制恶化、加重率增加、医疗资源消耗增加以及医疗支出增加有关。 3-5 最近的一项系统文献回顾和荟萃分析发现，不正确的吸入器技术在所有设备中都很常见，随着到 100% 的患者证明至少有一个错误。而且，