Since my memory on this subject goes back several decades, I thought I might share the old and the new theory on which inhaler to use on any given patient.  Those of you with a lung disease that requires inhaler therapy (and most common ones like asthma and COPD do) know that there are many ways your medications can be delivered.  There are metered dose inhalers, dry powder breath actuated inhalers, respimat inhalers, and nebulizers, and within each of these groups there can be some variation on how the device is used.  You also may know that some of the commonly used medications can be administered by several different types of inhalers, and some are only available with one type of inhaler.

I just finished reading several articles which tried to determine which type of inhaler was preferred by most pulmonary physicians.  There were graphs, charts and percentages, along with some analysis of the data presented.  The conclusion in these studies was that physicians thought that the medication was more important than the delivery device.

The reality here is that most of the medications in a class have equivalent effectiveness.  The overriding reason patients are given one inhaler over another often has nothing to do with medicine, but rather economics.

The formulary system in place for most insurance guides the patient to one medication over another, not on the basis of effectiveness, but on cost.

Before prescribing an inhaler most physicians will ask “What will the patient’s insurance cover?”