There are clear guidelines (GOLD) on which medication is appropriate for which patient depending on symptoms and risk for exacerbation.3 This helps make decision-making easier for clinicians and helps ensure optimal medication selection.
In contrast, there are no official guidelines regarding device selection. The guidelines briefly mention the importance of measuring the patient’s physical and cognitive ability to use the selected device but do not provide specific guidance on how to perform these evaluations and what to assess in these specific areas.3 Is a nebulizer appropriate? Which type of inhaler is best? Physicians who treat COPD are left to solve this on their own. Literature exists that can be helpful, and device manufacturers can be a useful source of information, but this still leaves the prescribing physician to sift through this information on their own.
This issue is compounded by the fact that device selection is not “owned” by a consistent stakeholder. Sometimes the primary care physician makes the decision, sometimes it is the pulmonologist. Device ownership can fall on practically any member of the extended COPD care team.
Finally, not all members of the COPD care team are adequately trained on device use.4