Table I Main Characteristics of Pressurized Metered-Dose Inhalers
表 I 加压计量吸入器的主要特点

Abbreviations: pMDI, pressurized metered-dose inhaler; HFA, hydrofluoroalkane; CFC, chlorofluorocarbon; MMAD, mass median aerodynamic diameter; m/s, meter per second; $\mu \mathrm{m}$$\mu \mathrm{m}$mum\mu \mathrm{m}, micrometer; $\mathrm{L}/\min$$\mathrm{L}/\min$L//min\mathrm{L} / \mathrm{min}, liter per minute.
缩写：pMDI，加压计量吸入器；HFA，氢氟烃；CFC，氯氟化碳；MMAD，质量中值空气动力学直径；m/s，米/秒； $\mu \mathrm{m}$$\mu \mathrm{m}$mum\mu \mathrm{m} ，微米； $\mathrm{L}/\min$$\mathrm{L}/\min$L//min\mathrm{L} / \mathrm{min} ，升/分钟。
performed inhalation correctly. ${}^{68}$${}^{68}$^(68){ }^{68} For the main DPI devices, the published lung deposition rates from individual studies (without direct comparisons) are as follows: Accuhaler ${}^{\mathbb{B}}7.6\mathrm{\%},{}^{70}$${}^{\mathbb{B}}7.6\mathrm{\%},{}^{70}$^(B)7.6%,^(70){ }^{\mathbb{B}} 7.6 \%,{ }^{70} Aerolizer ${}^{\circledR }13\mathrm{\%}-20\mathrm{\%},{}^{34,71}$${}^{\circledR }13\mathrm{\%}-20\mathrm{\%},{}^{34,71}$^(®)quad13%-20%,^(34,71)quad{ }^{\circledR} \quad 13 \%-20 \%,{ }^{34,71} \quad Breezhaler ${}^{\mathbb{B}}26.8\mathrm{\%}-39\mathrm{\%}$${}^{\mathbb{B}}26.8\mathrm{\%}-39\mathrm{\%}$^(B)quad26.8%-39%^{\mathbb{B}} \quad 26.8 \%-39 \%, ${}^{24,29}$${}^{24,29}$^(24,29){ }^{24,29} Easyhaler ${}^{\mathbb{R}}18.5\mathrm{\%}-31\mathrm{\%},{}^{71,72}$${}^{\mathbb{R}}18.5\mathrm{\%}-31\mathrm{\%},{}^{71,72}$^(R)18.5%-31%,^(71,72){ }^{\mathbb{R}} 18.5 \%-31 \%,{ }^{71,72} Genuair ${}^{\text{®}}30.1\mathrm{\%}-51.1\mathrm{\%},{}^{27,73,74}$${}^{\text{® }}30.1\mathrm{\%}-51.1\mathrm{\%},{}^{27,73,74}$^("® ")30.1%-51.1%,^(27,73,74)^{\text {® }} 30.1 \%-51.1 \%,{ }^{27,73,74} Handihaler ${}^{\mathbb{R}}9.8\mathrm{\%}-46.7\mathrm{\%},{}^{19,24,71}$${}^{\mathbb{R}}9.8\mathrm{\%}-46.7\mathrm{\%},{}^{19,24,71}$^(R)9.8%-46.7%,^(19,24,71){ }^{\mathbb{R}} 9.8 \%-46.7 \%,{ }^{19,24,71} Ingelheim inhaler ${}^{(8)}16\mathrm{\%}-$${}^{(8)}16\mathrm{\%}-$^((8))16%-{ }^{(8)} 16 \%- $59\mathrm{\%}{}^{75}$$59\mathrm{\%}{}^{75}$59%^(75)59 \%{ }^{75} NEXThaler ${}^{\mathbb{R}}39.4\mathrm{\%}-56\mathrm{\%},{}^{11,76}$${}^{\mathbb{R}}39.4\mathrm{\%}-56\mathrm{\%},{}^{11,76}$^(R)39.4%-56%,^(11,76){ }^{\mathbb{R}} 39.4 \%-56 \%,{ }^{11,76} Spinhaler ${}^{\mathbb{B}}11.5\mathrm{\%},{}^{75}$${}^{\mathbb{B}}11.5\mathrm{\%},{}^{75}$^(B)11.5%,^(75)^{\mathbb{B}} 11.5 \%,{ }^{75} Turbuhaler ${}^{\circledR }14.2\mathrm{\%}-69.3\mathrm{\%},{}^{21,42,77-79}$${}^{\circledR }14.2\mathrm{\%}-69.3\mathrm{\%},{}^{21,42,77-79}$^(®)14.2%-69.3%,^(21,42,77-79){ }^{\circledR} 14.2 \%-69.3 \%,{ }^{21,42,77-79} and Twisthaler ${}^{\circledR }36\mathrm{\%}-$${}^{\circledR }36\mathrm{\%}-$^(®)36%-{ }^{\circledR} 36 \%- $37\mathrm{\%}.{}^{80}$$37\mathrm{\%}.{}^{80}$37%.^(80)37 \% .{ }^{80} Similarly to all inhaler devices, other factors are probably influencing the lung deposition rate. ${}^{81}$${}^{81}$^(81){ }^{81} Although some studies have compared lung deposition in pMDIs and DPIs, their results are contradictory. ${}^{19,33}$${}^{19,33}$^(19,33){ }^{19,33}
正确进行吸入。 ${}^{68}$${}^{68}$^(68){ }^{68} 对于主要的干粉吸入器，个别研究（无直接比较）公布的肺沉积率如下：喷雾器 ${}^{\mathbb{B}}7.6\mathrm{\%},{}^{70}$${}^{\mathbb{B}}7.6\mathrm{\%},{}^{70}$^(B)7.6%,^(70){ }^{\mathbb{B}} 7.6 \%,{ }^{70} 喷雾器 ${}^{\circledR }13\mathrm{\%}-20\mathrm{\%},{}^{34,71}$${}^{\circledR }13\mathrm{\%}-20\mathrm{\%},{}^{34,71}$^(®)quad13%-20%,^(34,71)quad{ }^{\circledR} \quad 13 \%-20 \%,{ }^{34,71} \quad 微喷器 ${}^{\mathbb{B}}26.8\mathrm{\%}-39\mathrm{\%}$${}^{\mathbb{B}}26.8\mathrm{\%}-39\mathrm{\%}$^(B)quad26.8%-39%^{\mathbb{B}} \quad 26.8 \%-39 \% 、 ${}^{24,29}$${}^{24,29}$^(24,29){ }^{24,29} Easyhaler ${}^{\mathbb{R}}18.5\mathrm{\%}-31\mathrm{\%},{}^{71,72}$${}^{\mathbb{R}}18.5\mathrm{\%}-31\mathrm{\%},{}^{71,72}$^(R)18.5%-31%,^(71,72){ }^{\mathbb{R}} 18.5 \%-31 \%,{ }^{71,72} Genuair ${}^{\text{®}}30.1\mathrm{\%}-51.1\mathrm{\%},{}^{27,73,74}$${}^{\text{® }}30.1\mathrm{\%}-51.1\mathrm{\%},{}^{27,73,74}$^("® ")30.1%-51.1%,^(27,73,74)^{\text {® }} 30.1 \%-51.1 \%,{ }^{27,73,74} Handihaler ${}^{\mathbb{R}}9.8\mathrm{\%}-46.7\mathrm{\%},{}^{19,24,71}$${}^{\mathbb{R}}9.8\mathrm{\%}-46.7\mathrm{\%},{}^{19,24,71}$^(R)9.8%-46.7%,^(19,24,71){ }^{\mathbb{R}} 9.8 \%-46.7 \%,{ }^{19,24,71} Ingelheim 吸入器 ${}^{(8)}16\mathrm{\%}-$${}^{(8)}16\mathrm{\%}-$^((8))16%-{ }^{(8)} 16 \%- $59\mathrm{\%}{}^{75}$$59\mathrm{\%}{}^{75}$59%^(75)59 \%{ }^{75} NEXThaler ${}^{\mathbb{R}}39.4\mathrm{\%}-56\mathrm{\%},{}^{11,76}$${}^{\mathbb{R}}39.4\mathrm{\%}-56\mathrm{\%},{}^{11,76}$^(R)39.4%-56%,^(11,76){ }^{\mathbb{R}} 39.4 \%-56 \%,{ }^{11,76} Spinhaler ${}^{\mathbb{B}}11.5\mathrm{\%},{}^{75}$${}^{\mathbb{B}}11.5\mathrm{\%},{}^{75}$^(B)11.5%,^(75)^{\mathbb{B}} 11.5 \%,{ }^{75} Turbuhaler ${}^{\circledR }14.2\mathrm{\%}-69.3\mathrm{\%},{}^{21,42,77-79}$${}^{\circledR }14.2\mathrm{\%}-69.3\mathrm{\%},{}^{21,42,77-79}$^(®)14.2%-69.3%,^(21,42,77-79){ }^{\circledR} 14.2 \%-69.3 \%,{ }^{21,42,77-79} 和 Twisthaler ${}^{\circledR }36\mathrm{\%}-$${}^{\circledR }36\mathrm{\%}-$^(®)36%-{ }^{\circledR} 36 \%- $37\mathrm{\%}.{}^{80}$$37\mathrm{\%}.{}^{80}$37%.^(80)37 \% .{ }^{80} 与所有吸入器类似、其他因素也可能影响肺沉积率。 ${}^{81}$${}^{81}$^(81){ }^{81} 尽管一些研究对 pMDIs 和 DPIs 的肺沉积进行了比较，但其结果却相互矛盾。 ${}^{19,33}$${}^{19,33}$^(19,33){ }^{19,33}

Table 2 Main Characteristics of Dry Powder Inhalers
表 2 干粉吸入器的主要特点

Abbreviations: DPI, dry powder inhaler; MMAD, mass median aerodynamic diameter; m/s, meter per second; $\mu \mathrm{m}$$\mu \mathrm{m}$mum\mu \mathrm{m}, micrometer; L/min, liter per minute.
缩写：DPI，干粉吸入器；MMAD，质量中值空气动力学直径；m/s，米/秒； $\mu \mathrm{m}$$\mu \mathrm{m}$mum\mu \mathrm{m} ，微米；L/min，升/分钟。

Respimat ${}^{(\circledR )}$${}^{(\circledR )}$^((®))^{(®)} (SMI) has largely exhibited high lung deposition rates that range from $39.2\mathrm{\%}$$39.2\mathrm{\%}$39.2%39.2 \% to $67\mathrm{\%},{}^{27,38,48,49,74,82-84}$$67\mathrm{\%},{}^{27,38,48,49,74,82-84}$67%,^(27,38,48,49,74,82-84)67 \%,{ }^{27,38,48,49,74,82-84} with different inspiratory flow rates (high and low) and irrespective of humidity. ${}^{85}$${}^{85}$^(85){ }^{85} Compared with other devices, SMI showed higher lung deposition than pMDIs (including those with a chamber or spacer) or DPIs. ${}^{27,48,74,83,86}$${}^{27,48,74,83,86}$^(27,48,74,83,86){ }^{27,48,74,83,86}
Respimat ${}^{(\circledR )}$${}^{(\circledR )}$^((®))^{(®)} （SMI）在很大程度上表现出较高的肺沉积率，在不同吸气流速（高和低）和湿度条件下，肺沉积率从 $39.2\mathrm{\%}$$39.2\mathrm{\%}$39.2%39.2 \% 到 $67\mathrm{\%},{}^{27,38,48,49,74,82-84}$$67\mathrm{\%},{}^{27,38,48,49,74,82-84}$67%,^(27,38,48,49,74,82-84)67 \%,{ }^{27,38,48,49,74,82-84} 不等。 ${}^{85}$${}^{85}$^(85){ }^{85} 与其他设备相比，SMI 的肺沉积率高于 pMDIs（包括带有腔体或隔板的设备）或 DPIs。 ${}^{27,48,74,83,86}$${}^{27,48,74,83,86}$^(27,48,74,83,86){ }^{27,48,74,83,86}

We also evaluated the AEV. Inhalation devices with a high AEV might have a short spray duration and vice versa. With pMDIs, the aerosol exits through a nozzle at
我们还对 AEV 进行了评估。AEV 高的吸入装置可能喷雾持续时间短，反之亦然。使用 pMDIs 时，气溶胶从喷嘴喷出的速度为

Table 3 Main Characteristics of the Soft Mist Inhaler
表 3 软雾吸入器的主要特点

Abbreviations: SMI, soft mist inhaler; MMAD, mass median aerodynamic diameter; m/s, meter per second; $\mu \mathrm{m}$$\mu \mathrm{m}$mum\mu \mathrm{m}, micrometer; L/min, liter per minute.
缩写：SMI，软雾吸入器；MMAD，质量中值空气动力学直径；m/s，米/秒； $\mu \mathrm{m}$$\mu \mathrm{m}$mum\mu \mathrm{m} ，微米；L/min，升/分钟。
a very high rate of more than $3\mathrm{m}/\mathrm{s}.{}^{87}$$3\mathrm{m}/\mathrm{s}.{}^{87}$3m//s.^(87)3 \mathrm{~m} / \mathrm{s} .{ }^{87} However, the AEV of the SMI is much slower, at $0.84-0.72\mathrm{m}/\mathrm{s}$$0.84-0.72\mathrm{m}/\mathrm{s}$0.84-0.72m//s0.84-0.72 \mathrm{~m} / \mathrm{s}, and the aerosol cloud lasts longer. ${}^{88-90}$${}^{88-90}$^(88-90){ }^{88-90}
然而，SMI 的 AEV 要慢得多，为 $0.84-0.72\mathrm{m}/\mathrm{s}$$0.84-0.72\mathrm{m}/\mathrm{s}$0.84-0.72m//s0.84-0.72 \mathrm{~m} / \mathrm{s} ，气溶胶云持续的时间也更长。 ${}^{88-90}$${}^{88-90}$^(88-90){ }^{88-90}

It has also been observed that the distribution of the deposition sites of inhaled particles is strongly dependent on their aerodynamic diameters. ${}^{69}$${}^{69}$^(69){ }^{69} This SLR found that pMDIs generally produce at least medium-sized particles, with a significant rate of extrafine particles. The observed MMAD of conventional pMDIs varies from 1.22 to 8 $\mu \mathrm{m},{}^{35,91,92}$$\mu \mathrm{m},{}^{35,91,92}$mum,^(35,91,92)\mu \mathrm{m},{ }^{35,91,92} from 1.19 to $3.57\mu \mathrm{m}$$3.57\mu \mathrm{m}$3.57 mum3.57 \mu \mathrm{~m} when a valved holding chamber or spacer is used, ${}^{31,35,93}$${}^{31,35,93}$^(31,35,93){ }^{31,35,93} and from 0.72 to $2.0\mu \mathrm{m}$$2.0\mu \mathrm{m}$2.0 mum2.0 \mu \mathrm{~m} with Modulite ${}^{\circledR }.{}^{65,66}$${}^{\circledR }.{}^{65,66}$^(®).^(65,66){ }^{\circledR} .{ }^{65,66} Regarding particle size data for DPIs, depending on the device and drug, MMDAs vary from 1.40 to $4.8\mu \mathrm{m}{.}^{11,19,21,24,27-29,36,37,74,76}$$4.8\mu \mathrm{m}{.}^{11,19,21,24,27-29,36,37,74,76}$4.8 mum.^(11,19,21,24,27-29,36,37,74,76)4.8 \mu \mathrm{~m} .^{11,19,21,24,27-29,36,37,74,76} Conversely, SMI
另据观察，吸入颗粒的沉积点分布在很大程度上取决于其空气动力学直径。 ${}^{69}$${}^{69}$^(69){ }^{69} 该 SLR 发现，pMDIs 通常至少会产生中等大小的微粒，并产生大量超细微粒。传统 pMDIs 观察到的 MMAD 从 1.22 到 8 $\mu \mathrm{m},{}^{35,91,92}$$\mu \mathrm{m},{}^{35,91,92}$mum,^(35,91,92)\mu \mathrm{m},{ }^{35,91,92} $3.57\mu \mathrm{m}$$3.57\mu \mathrm{m}$3.57 mum3.57 \mu \mathrm{~m} ${}^{31,35,93}$${}^{31,35,93}$^(31,35,93){ }^{31,35,93} 不等，使用 Modulite 时从 0.72 到 $2.0\mu \mathrm{m}$$2.0\mu \mathrm{m}$2.0 mum2.0 \mu \mathrm{~m} ${}^{\circledR }.{}^{65,66}$${}^{\circledR }.{}^{65,66}$^(®).^(65,66){ }^{\circledR} .{ }^{65,66} 关于 DPIs 的粒度数据，根据设备和药物的不同，MMDA 从 1.40 到 $4.8\mu \mathrm{m}{.}^{11,19,21,24,27-29,36,37,74,76}$$4.8\mu \mathrm{m}{.}^{11,19,21,24,27-29,36,37,74,76}$4.8 mum.^(11,19,21,24,27-29,36,37,74,76)4.8 \mu \mathrm{~m} .^{11,19,21,24,27-29,36,37,74,76} 不等。

Table 4 Main Factors Associated to Inspiratory Flow Rate
表 4 与吸气流速有关的主要因素

Abbreviations: COPD, chronic obstructive pulmonary disease; DPIs, dry powder inhalers.
缩写：缩写：COPD，慢性阻塞性肺病；DPIs，干粉吸入器。
generates a cloud that contains an aerosol with a fine particle fraction of around $3.7\mu \mathrm{m}.{}^{74}$$3.7\mu \mathrm{m}.{}^{74}$3.7 mum.^(74)3.7 \mu \mathrm{~m} .{ }^{74} It is estimated that $60\mathrm{\%}$$60\mathrm{\%}$60%60 \% of the particles reach a MMAD $<5\mu \mathrm{m}$$<5\mu \mathrm{m}$< 5mum<5 \mu \mathrm{~m} with SMI. ${}^{85}$${}^{85}$^(85){ }^{85} The reported rate with pMDIs and DPIs (indirect comparison) is not that high. ${}^{27,28,74,94}$${}^{27,28,74,94}$^(27,28,74,94){ }^{27,28,74,94}
据估计， $60\mathrm{\%}$$60\mathrm{\%}$60%60 \% 的颗粒会到达使用 SMI 的 MMAD $<5\mu \mathrm{m}$$<5\mu \mathrm{m}$< 5mum<5 \mu \mathrm{~m} 。 ${}^{85}$${}^{85}$^(85){ }^{85} 报告的 pMDIs 和 DPIs 的比率（间接比较）并不高。 ${}^{27,28,74,94}$${}^{27,28,74,94}$^(27,28,74,94){ }^{27,28,74,94}

Another relevant outcome when using inhalation devices is the lung distribution pattern (through the central and peripheral regions). All inhalation devices have been shown to reach both central and peripheral areas. SMI data suggest that lung distribution pattern might be better than pMDIs, with a higher distribution in bronchial trees and peripheral regions. ${}^{11,28,49,60,65,66,73,74,82,95,96}$${}^{11,28,49,60,65,66,73,74,82,95,96}$^(11,28,49,60,65,66,73,74,82,95,96){ }^{11,28,49,60,65,66,73,74,82,95,96} More specifically, a comparative study found mean peripheral, intermediate and central lung deposition, and peripheral zone/ central zone ratio of $5.0\mathrm{\%}-9.4\mathrm{\%},4.8\mathrm{\%}-11.3\mathrm{\%},4.5\mathrm{\%}-$$5.0\mathrm{\%}-9.4\mathrm{\%},4.8\mathrm{\%}-11.3\mathrm{\%},4.5\mathrm{\%}-$5.0%-9.4%,4.8%-11.3%,4.5%-5.0 \%-9.4 \%, 4.8 \%-11.3 \%, 4.5 \%- $10.4\mathrm{\%},1.01-1.16$$10.4\mathrm{\%},1.01-1.16$10.4%,1.01-1.1610.4 \%, 1.01-1.16 with Respimat ${}^{(R)}$${}^{(R)}$^((R)){ }^{(R)} vs $3.8\mathrm{\%},4.9\mathrm{\%},5.6\mathrm{\%}$$3.8\mathrm{\%},4.9\mathrm{\%},5.6\mathrm{\%}$3.8%,4.9%,5.6%3.8 \%, 4.9 \%, 5.6 \%, 1.36 with pMDIs, respectively. ${}^{49}$${}^{49}$^(49){ }^{49} Comparative data between pMDIs and DPIs are conflicting. ${}^{33,46}$${}^{33,46}$^(33,46){ }^{33,46}
使用吸入装置的另一个相关结果是肺部分布模式（通过中心和外围区域）。所有吸入装置都已证明可到达中心和外周区域。SMI 数据表明，肺部分布模式可能优于 pMDIs，在支气管树和外周区域的分布较多。 ${}^{11,28,49,60,65,66,73,74,82,95,96}$${}^{11,28,49,60,65,66,73,74,82,95,96}$^(11,28,49,60,65,66,73,74,82,95,96){ }^{11,28,49,60,65,66,73,74,82,95,96} 更具体地说，一项比较研究发现，Respimat ${}^{(R)}$${}^{(R)}$^((R)){ }^{(R)} 与 pMDIs 的 $3.8\mathrm{\%},4.9\mathrm{\%},5.6\mathrm{\%}$$3.8\mathrm{\%},4.9\mathrm{\%},5.6\mathrm{\%}$3.8%,4.9%,5.6%3.8 \%, 4.9 \%, 5.6 \% 和 $5.0\mathrm{\%}-9.4\mathrm{\%},4.8\mathrm{\%}-11.3\mathrm{\%},4.5\mathrm{\%}-$$5.0\mathrm{\%}-9.4\mathrm{\%},4.8\mathrm{\%}-11.3\mathrm{\%},4.5\mathrm{\%}-$5.0%-9.4%,4.8%-11.3%,4.5%-5.0 \%-9.4 \%, 4.8 \%-11.3 \%, 4.5 \%- $10.4\mathrm{\%},1.01-1.16$$10.4\mathrm{\%},1.01-1.16$10.4%,1.01-1.1610.4 \%, 1.01-1.16 的平均外周、中间和中心肺沉积以及外周区/中心区比率分别为 $5.0\mathrm{\%}-9.4\mathrm{\%},4.8\mathrm{\%}-11.3\mathrm{\%},4.5\mathrm{\%}-$$5.0\mathrm{\%}-9.4\mathrm{\%},4.8\mathrm{\%}-11.3\mathrm{\%},4.5\mathrm{\%}-$5.0%-9.4%,4.8%-11.3%,4.5%-5.0 \%-9.4 \%, 4.8 \%-11.3 \%, 4.5 \%- $10.4\mathrm{\%},1.01-1.16$$10.4\mathrm{\%},1.01-1.16$10.4%,1.01-1.1610.4 \%, 1.01-1.16 和 $3.8\mathrm{\%},4.9\mathrm{\%},5.6\mathrm{\%}$$3.8\mathrm{\%},4.9\mathrm{\%},5.6\mathrm{\%}$3.8%,4.9%,5.6%3.8 \%, 4.9 \%, 5.6 \% 和 1.36。 ${}^{49}$${}^{49}$^(49){ }^{49} pMDIs 和 DPIs 之间的比较数据相互矛盾。 ${}^{33,46}$${}^{33,46}$^(33,46){ }^{33,46}

The other main focus of this project was the inspiratory flow rate. First, it is important to consider the factors associated with inspiratory flow rate (Table 4). Similar to lung deposition, some of these factors relate to the patient’s and COPD’s characteristics, while other factors relate to the inhaler device, such as the intrinsic resistance. ${}^{6,10,13-17,43,45,97,98}$${}^{6,10,13-17,43,45,97,98}$^(6,10,13-17,43,45,97,98){ }^{6,10,13-17,43,45,97,98}
本项目的另一个重点是吸气流速。首先，必须考虑与吸气流速相关的因素（表 4）。与肺沉积类似，其中一些因素与患者和慢性阻塞性肺病的特征有关，而其他因素则与吸入器装置有关，例如内在阻力。 ${}^{6,10,13-17,43,45,97,98}$${}^{6,10,13-17,43,45,97,98}$^(6,10,13-17,43,45,97,98){ }^{6,10,13-17,43,45,97,98}

Overall, two main driving forces can affect the performance of DPIs: the inspiratory flow generated by the patient and the turbulence produced inside the device, the latter of which solely depends on the original technical
总之，有两种主要驱动力会影响干粉吸入器的性能：患者产生的吸气流量和设备内部产生的湍流，后者完全取决于原始技术。

Table 5 General Conclusions Regarding Lung Deposition and Inspiratory Flow Rate in Chronic Obstructive Pulmonary Disease
表 5 有关慢性阻塞性肺病肺沉积和吸气流速的一般结论

Abbreviations: COPD, chronic obstructive pulmonary disease; MMAD, mass median aerodynamic diameter; $\mu \mathrm{m}$$\mu \mathrm{m}$mum\mu \mathrm{m}, micrometer; DPI, dry powder inhaler; SMI, soft mist inhaler.
缩写：缩写： COPD，慢性阻塞性肺病；MMAD，质量中值空气动力学直径； $\mu \mathrm{m}$$\mu \mathrm{m}$mum\mu \mathrm{m} ，微米；DPI，干粉吸入器；SMI，软雾吸入器。
also taking into account all the factors and bases that determine the effectiveness of the inhaled route of administration.
还要考虑到决定吸入给药途径有效性的所有因素和依据。

Table 6 Experts’ Recommendations for the Selection of the Appropriate Inhalation Device in Chronic Obstructive Pulmonary Disease
表 6 专家对慢性阻塞性肺病患者选择适当吸入装置的建议

Abbreviations: COPD, chronic obstructive pulmonary disease; pMDI, pressurized metered-dose inhaler; SMI, soft mist inhaler.
缩写：缩写： COPD，慢性阻塞性肺病；pMDI，加压计量吸入器；SMI，软雾吸入器。

The delivery of drugs by inhalation is an integral component in the treatment of COPD. A growing number of inhalation devices, whose designs and characteristics vary, have been engineered in recent years to treat COPD and other respiratory diseases. ${}^{111}$${}^{111}$^(111){ }^{111} Therefore, selecting the most appropriate device that meets each individual patient’s needs is vital in clinical practice. Several factors have been proposed that should be considered when choosing an inhalation device. These include the patient’s lung function, device handling, inhalation technique, and preferences. ${}^8$${}^8$^(8){ }^{8} However, according to a published expert opinion, the two most important characteristics for an inhaler used by patients with COPD are that the device permits a high pulmonary deposition of the drug and allows its delivery at low inspiratory flows. ${}^9$${}^9$^(9){ }^{9}
吸入给药是治疗慢性阻塞性肺病不可或缺的组成部分。近年来，用于治疗慢性阻塞性肺病和其他呼吸系统疾病的吸入装置越来越多，其设计和特性也各不相同。 ${}^{111}$${}^{111}$^(111){ }^{111} 因此，在临床实践中，选择最合适的设备以满足每个患者的需求至关重要。已经提出了在选择吸入装置时应考虑的几个因素。这些因素包括患者的肺功能、装置操作、吸入技术和偏好。 ${}^8$${}^8$^(8){ }^{8} 然而，根据已发表的专家意见，慢性阻塞性肺病患者使用的吸入器有两个最重要的特征，即吸入器允许药物在肺部高度沉积，并允许在低吸气流量下给药。 ${}^9$${}^9$^(9){ }^{9}