Table 6.

Experts’ Recommendations for the Selection of the Appropriate Inhalation Device in Chronic Obstructive Pulmonary Disease

#	It is Strongly Recommended to …
1	Consider COPD pathophysiological aspects as well as patients’ clinical status and disease severity/evolution when selecting an inhalation device
2	Take into account the specific characteristics of each inhalation device
3	Assess patients’ ability to perform a correct inhalation maneuver and the specific requirements for each inhalation device
4	Evaluate patients’ inspiratory flow rate or inspiratory capacity before selecting an inhalation device
5	Take into account patients’ history of exacerbations or other events that may affect their ability to perform adequate inhalation
6	Regularly review patients’ inhalation maneuver and check whether the inhalation device meets their needs
7	Use an active inhalation device, such as pMDI or SMI, in patients with reduced inspiratory capacity
8	Consider using a valved holding chamber with SMI or pMDI devices in fragile patients with inspiratory and/or coordination difficulties
9	Use inhalation devices that generate a low oropharyngeal and high lung deposition
10	Check patients’ inhalation maneuver during every visit and, where necessary, resolve errors or even change the inhaler

Abbreviations: COPD, chronic obstructive pulmonary disease; pMDI, pressurized metered-dose inhaler; SMI, soft mist inhaler.