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Several devices are used for long-acting muscarinic antagonist (LAMA)/long-acting b2 agonist (LABA) inhalation therapy for chronic obstructive pulmonary disease (COPD) patients but what is the optimum device? On the basis of Bayesian network metaanalysis, all the LAMA/LABA fixed-dose combinations are at present evaluated as having similar efficacy in terms of forced expiratory volume in 1 second (FEV1). However, in recent years, the association between the residual volume and the symptoms of COPD has been drawing attention. In Japan, the devices available for LAMA/LABA are drypowder inhalers (DPIs) and soft-mist inhalers (SMIs). A previous report showed improvements in functional residual capacity and residual volume (RV) with an SMI-type LAMA/LABA over the same LABA or LAMA given as a single agent. Other researchers have reported that the deposition pattern within the lungs was more peripheral for SMI than for DPI. Since April 2015, among 9 patients in our hospital with COPD who sequentially used 2 kinds of LAMA/ LABA devices, 8 patients (mean age: 77.5 years; range: 67–87 years; mean pack years: 84.2; range: 33.8–144; all patients were male) initially took DPIglycopyrronium plus indacaterol for at least 8 weeks and then switched to SMI-tiotropium plus olodaterol. One patient switched from SMI to DPI. Because SMItiotropium plus olodaterol became commercially available 2 years after DPI-glycopyrronium plus indacaterol had become available in Japan, most patients in this study switched from DPI to SMI. All patients were using LAMA as a monotherapy before they started the combination treatment. We examined changes in lung function measures by comparing the measures taken before and after the switch to the SMI device. The first “before switch” lung function was measured on the day it was switched and the last “after switch” lung function was measured after 6 to 10 weeks. The lung function values were measured 2 to 8 hours after the last inhalation dose, and the time

Relationship between lung function and inhalation devices for LAMA/LABA therapy for chronic obstructive pulmonary disease