Interactive Device Selection Tool for COPD
Select the optimal device for inhalation therapy for your patient by moving your mouse to the area of the chart that best describes your patient's level of cognitive function and/or manual dexterity, as well as their peak inspiratory flow. Click on the ⓘ fields for some guidance. Once you have made your selection, click on the relevant device for more details.
Optimal
>60 L/min for low to medium-high resistance DPIs
>30 L/min for high-resistance DPIs
Impaired
Cognitive: Dementia, intellectual disabilities, memory loss, trouble completing tasks, and/or difficulty following instructions
Manual: Impaired fine motor activities, tremor, reduced handgrip strength, arthritis
Recommendations:
Lung Secretion
YES
Suboptimal <60 L/min for low to medium-high resistance DPIs
<30 L/min for high-resistance DPIs
DPI
SMI
Nebulised saline and/or PEP device: Consider in patients who feel congested and/or have sticky mucus and/or mucus plugs present on CT scan.
Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD report recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
YES
Suboptimal
Optimal
Peak Inspiratory Flow
IMPAIRED
NORMAL
Cognitive Function and/or Manual Dexterity
pMDI: Consider in patients with normal cognitive and manual capabilities. Patient‘s instructions should be: "Inhale slow and steady.“ Check manufacturer‘s instruction for more information.
Advantage: Broad range of drugs and drug combinations available, portable, generally reimbursed. Disadvantage: High degree of patient's coordination required, relatively high carbon footprint.
pMDI + Valved Holding Chamber
pMDI + Valved Holding Chamber: Consider VHC in patients with poor hand-breath coordination and those using corticosteroids in pMDIs. Advantage: Reduced dysphonia, reduced oropharyngeal deposition. Disadvantage: Higher bulkiness, higher maintenance requirements compared to pMDI alone.
Recommendations:
Select an option above by clicking on it
Nebuliser
pMDI + Valved Holding Chamber
Recommendations:
pMDI + Valved Holding Chamber: Consider VHC in patients with poor hand-breath coordination and those using corticosteroids in pMDIs. Advantage: Reduced dysphonia, reduced oropharyngeal deposition. Disadvantage: Higher bulkiness, higher maintenance requirements compared to pMDI alone.
Select an option above by clicking on it
Nebuliser
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report 2025 states that a nebuliser should be considered for patients unable to use pMDI with or without spacer, DPI, or SMI, or those who prefer nebulisers over other hand-held devices:
Consider maintenance nebuliser therapy if long-acting bronchodilators (LABA and LAMA), inhaled corticosteroid (ICS), or dual phosphodiesterase inhibitor (PDE3/ PDE4) solutions are available in your country.
Consider adding nebulized short-acting bronchodilators (SABA and SAMA) to inhaled therapy for patients experiencing acute or persistent symptoms.
pMDI + Valved Holding Chamber
pMDI + Valved Holding Chamber: Consider VHC in patients with poor hand-breath coordination and those using corticosteroids in pMDIs. Advantage: Reduced dysphonia, reduced oropharyngeal deposition. Disadvantage: Higher bulkiness, higher maintenance requirements compared to pMDI alone.
Recommendations:
SMI
DPI
pMDI
pMDI: Consider in patients with normal cognitive and manual capabilities. Patient‘s instructions should be: "Inhale slow and steady.“ Check manufacturer‘s instruction for more information.
Advantage: Broad range of drugs and drug combinations available, portable, generally reimbursed. Disadvantage: High degree of patient's coordination required, relatively high carbon footprint.
Recommendations:
Nebuliser
Select an option above by clicking on it
Select an option above by clicking on it
Select an option above by clicking on it
Nebuliser
SMI
pMDI
Recommendations:
DPI: Consider in patients with normal cognitive and manual capabilities, and optimal PIF. Patient‘s instructions should be: "Inhale hard and fast.“ Check manufacturer‘s instruction for more information.
Advantage: Broad range of drugs and drug combinations available, portable, generally reimbursed. Disadvantage: Patients require high inspiratory flow to de-aggregate medication. Some patients with COPD cannot achieve an optimal PIF.
SMI: Consider in patients with normal cognitive and manual capabilities, Patient‘s instructions should be: "Inhale slow and steady.“ Check manufacturer‘s instruction for more information.
Advantage: Portable, generally reimbursed. Disadvantage: Inhaled corticosteroids are not available in this device.
Select an option above by clicking on it
pMDI
Use in COPD patients who feel congested and have sticky mucus, or have mucus plugs present on CT scan. Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD guideline recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Use in COPD patients who feel congested and have sticky mucus, or have mucus plugs present on CT scan. Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD guideline recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Use in COPD patients who feel congested and have sticky mucus, or have mucus plugs present on CT scan. Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD guideline recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Use in COPD patients who feel congested and have sticky mucus, or have mucus plugs present on CT scan. Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD guideline recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Use in COPD patients who feel congested and have sticky mucus, or have mucus plugs present on CT scan. Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD guideline recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Use in COPD patients who feel congested and have sticky mucus, or have mucus plugs present on CT scan. Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD guideline recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Disclaimer: The proposals of the device are based on the recommendations of international guidelines. However, the interactive Device Selection Tool does not replace the expertise of the treating healthcare professional.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report 2025 states that a nebuliser should be considered for patients unable to use pMDI with or without spacer, DPI, or SMI, or those who prefer nebulisers over other hand-held devices:
Consider maintenance nebuliser therapy if long-acting bronchodilators (LABA and LAMA), inhaled corticosteroid (ICS), or dual phosphodiesterase inhibitor (PDE3/ PDE4) solutions are available in your country.
Consider adding nebulized short-acting bronchodilators (SABA and SAMA) to inhaled therapy for patients experiencing acute or persistent symptoms.
DPI: Consider in patients with normal cognitive and manual capabilities, and optimal PIF. Patient‘s instructions should be: "Inhale hard and fast.“ Check manufacturer‘s instruction for more information.
Advantage: Broad range of drugs and drug combinations available, portable, generally reimbursed. Disadvantage: Patients require high inspiratory flow to de-aggregate medication. Some patients with COPD cannot achieve an optimal PIF.
SMI: Consider in patients with normal cognitive and manual capabilities, Patient‘s instructions should be: "Inhale slow and steady.“ Check manufacturer‘s instruction for more information.
Advantage: Portable, generally reimbursed. Disadvantage: Inhaled corticosteroids are not available in this device.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report 2025 states that a nebuliser should be considered for patients unable to use pMDI with or without spacer, DPI, or SMI, or those who prefer nebulisers over other hand-held devices:
Consider maintenance nebuliser therapy if long-acting bronchodilators (LABA and LAMA), inhaled corticosteroid (ICS), or dual phosphodiesterase inhibitor (PDE3/ PDE4) solutions are available in your country.
Consider adding nebulized short-acting bronchodilators (SABA and SAMA) to inhaled therapy for patients experiencing acute or persistent symptoms.
pMDI: Consider in patients with normal cognitive and manual capabilities. Patient‘s instructions should be: "Inhale slow and steady.“ Check manufacturer‘s instruction for more information.
Advantage: Broad range of drugs and drug combinations available, portable, generally reimbursed. Disadvantage: High degree of patient's coordination required, relatively high carbon footprint.
SMI: Consider in patients with normal cognitive and manual capabilities, Patient‘s instructions should be: "Inhale slow and steady.“ Check manufacturer‘s instruction for more information.
Advantage: Portable, generally reimbursed. Disadvantage: Inhaled corticosteroids are not available in this device.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report 2025 states that a nebuliser should be considered for patients unable to use pMDI with or without spacer, DPI, or SMI, or those who prefer nebulisers over other hand-held devices:
Consider maintenance nebuliser therapy if long-acting bronchodilators (LABA and LAMA), inhaled corticosteroid (ICS), or dual phosphodiesterase inhibitor (PDE3/ PDE4) solutions are available in your country.
Consider adding nebulized short-acting bronchodilators (SABA and SAMA) to inhaled therapy for patients experiencing acute or persistent symptoms.
If lung secretion is present, click "yes" For more information click on ⓘ
Nebulised saline | O-PEP
Chest congestion, sticky mucus, mucus overproduction, mucus plugging on CT scan
YES
YES
Lung Secretion
If lung secretion is present, click "yes" For more information click on ⓘ
Nebulised saline | O-PEP
Chest congestion, sticky mucus, mucus overproduction, mucus plugging on CT scan
YES
YES
Lung Secretion
If lung secretion is present, click "yes" For more information click on ⓘ
Nebulised saline | O-PEP
Chest congestion, sticky mucus, mucus overproduction, mucus plugging on CT scan
YES
YES
Lung Secretion
If lung secretion is present, click "yes" For more information click on ⓘ
Nebulised saline | O-PEP
Chest congestion, sticky mucus, mucus overproduction, mucus plugging on CT scan
YES
YES
Lung Secretion
If lung secretion is present, click "yes" For more information click on ⓘ
Nebulised saline | O-PEP
Chest congestion, sticky mucus, mucus overproduction, mucus plugging on CT scan
YES
YES
Lung Secretion
If lung secretion is present, click "yes" For more information click on ⓘ
Nebulised saline | O-PEP
Chest congestion, sticky mucus, mucus overproduction, mucus plugging on CT scan
Nebulised saline and/or PEP device: Consider in patients who feel congested and/or have sticky mucus and/or mucus plugs present on CT scan.
Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD report recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Nebulised saline and/or PEP device: Consider in patients who feel congested and/or have sticky mucus and/or mucus plugs present on CT scan.
Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD report recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Nebulised saline and/or PEP device: Consider in patients who feel congested and/or have sticky mucus and/or mucus plugs present on CT scan.
Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD report recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Nebulised saline and/or PEP device: Consider in patients who feel congested and/or have sticky mucus and/or mucus plugs present on CT scan.
Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD report recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Nebulised saline and/or PEP device: Consider in patients who feel congested and/or have sticky mucus and/or mucus plugs present on CT scan.
Nebulised saline thins sticky mucus and helps patients to clear their airways. GOLD report recommends oscillating PEP therapy for mucus mobilisation. Mucus clearance treatments may improve symptoms and quality of life in COPD patients.
Click here to learn more about Selecting the Inhalation Device Most Likely to Benefit Your Patients with COPD.