Adequacy of inhaler technique used by people with asthma or chronic obstructive pulmonary disease

Abstract

INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) are ongoing concerns to the health system. Poor inhaler technique results in less than optimal delivery of medicine to the lungs and consequent inadequate symptom control. AIM: This study aimed to assess inhaler technique amongst people with asthma and/or COPD. The secondary aims were to investigate who provided education on inhaler technique and whether age, gender or ethnicity was associated with poor inhaler technique. METHODS: People with asthma or COPD who presented to a community pharmacy with a prescription for a respiratory inhaler were invited to participate in the study. Participants completed a brief questionnaire and had their inhaler technique assessed against a standard checklist. RESULTS: There were 103 participants from 26 pharmacies, 86 with asthma and 17 with COPD. Just over half (52.5%) of the assessments indicated good inhaler technique, with 68% of people using the Turbuhaler having good technique compared to 53% for the pressurised metered dose inhaler (pMDI) with spacer and 47% for the pMDI alone. The majority of people (76%) received their initial inhaler technique instruction from their doctor. Over half of participants did not recall having their inhaler technique rechecked. DISCUSSION: After prescribing appropriate therapy, correct inhaler technique is a cornerstone of achieving adequate therapy. Rechecking inhaler technique is a gap in care that needs to be addressed from an interdisciplinary perspective. KEYWORDS: Asthma; chronic obstructive pulmonary disease; dry powder inhalers; metered dose inhalers; spacer inhalers

Optimizing inhaler use by pharmacist-provided education to community-dwelling elderly

“…[4] Despite the advantages of this mode of drug administration, many studies report suboptimal inhaler technique with all device types including metered-dose inhalers (MDIs), MDI use with spacer devices, and breathe-actuated dry powder inhalers (DPIs). [5][6][7][8] Poor patient self-administered inhaler technique is often related to poor outcomes such as increased emergency room visits, use of short-course steroids, antimicrobial use, and poor disease control. [5] Using an inhaler appropriately requires a certain degree of coordination and dexterity.…”

“…Yet, several studies have shown that patients often exhibited suboptimal technique in as little as three days after initial training. [6,13] Assessing a patient's ability to correctly use an inhaled medication is frequently based on checklists [7,8,[14][15][16] or essential steps described in manufacturer instructions and national guidelines. However, there is no standardized checklist for technique assessment used across research studies in the United States.…”

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

“…[3][4][5][6][7][8][9] Inhalation therapy is of paramount importance in the treatment of respiratory conditions. 3,4,[14][15][16][17][18][19] Regarding IT, evidence in the literature suggests that 50%-100% of patients perform errors while using their inhalers. 3,4,[14][15][16][17][18][19] Regarding IT, evidence in the literature suggests that 50%-100% of patients perform errors while using their inhalers.…”

An evaluation of a multi-site community pharmacy–based chronic obstructive pulmonary disease support service

“…As FEV worsens, then long‐acting beta‐agonists and muscarinic antagonists are introduced as combination therapy with the final option being to introduce inhaled corticosteroids [7]. The effectiveness of this approach is determined by the patient's ability to use an inhaler correctly[8] and by their willingness to use it as agreed with the prescriber [9]. Devices such as the In‐Check Dial (Clement Clarke International, Harlow, UK) are available to ensure that the type of inhaler selected for a patient is appropriate for their pulmonary function [10].…”