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Rational selection of inhalation devices in the treatment of chronic obstructive pulmonary disease by means of the System of Objectified Judgement Analysis (SOJA)
  1. Robert Janknegt1,
  2. johan Kooistra2,
  3. Esther Metting3,
  4. Richard Dekhuijzen4
  1. 1 Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, Netherlands
  2. 2 Maarssen, Netherlands
  3. 3 Groningen University Department of Health Sciences, Groningen, Groningen, Netherlands
  4. 4 University Medical Center Nijmegen, Nijmegen, Gelderland, Netherlands
  1. Correspondence to Dr Robert Janknegt, Zuyderland Medical Centre Sittard-Geleen, 6130 MB Sittard-Geleen, The Netherlands; rob.janknegt{at}


Objectives The large number of available medicines and devices makes it almost impossible to have sufficient knowledge of each individual medicine and device, especially for general practitioners. This may lead to suboptimal treatment, more exacerbations, hospitalisations and higher treatment costs. Reducing the number of medicines and devices, based on rational criteria, allows physicians and pharmacists to build experience with a more limited set of medicines and to standardise the inhalation instructions.

Methods In this study inhalers are compared by means of the System of Objectified Judgement Analysis (SOJA) method. The following selection criteria were applied: uniformity in device, number of steps per inhalation, risk of errors, hygienic aspects, feedback mechanism, and risk of inhalation with an empty inhaler.

Results Substantial differences were seen in the overall scores, with the Ellipta device showing the highest score, followed by Diskus/Accuhaler, Genuair and Nexthaler. Several devices require more or less identical techniques, such Ellipta and Diskus/Accuhaler as well as Genuair and Novolizer. When patients use these devices in combination this increases their uniformity, because additional medicines become available for the devices: starting therapy with Diskus or Novolizer and follow-up with Ellipta or Genuair. The resistance of Respimat and Breezhaler is lower than that of other devices, which makes these devices suitable for patients who cannot generate sufficient inhalation flow.

Conclusions A substantial reduction of inhalers, combined with optimal and standardised instructions, should improve the care of patients with chronic obstructive pulmonary disease.

  • clinical pharmacy
  • drug formulary management
  • drug procurement
  • health economics
  • thoracic medicine

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