Inhaler choice in primary practice

Abstract

A broad range of inhaler devices is available for physicians to prescribe. Although newer devices are often easier to use than conventional pressurised metered-dose inhalers (pMDIs), many patients still use inhalers sub-optimally. Physicians must become familiar with the characteristics of several inhalers and choose the device that their patients can use correctly and beneficially if they are to prescribe successfully to those with chronic obstructive pulmonary disease (COPD). The selection of a device may also be influenced by patient comorbidities and by their ability to handle and inhale correctly from the device. A further challenge in the COPD setting is measuring the desired treatment outcome.A simple algorithm or checklist can guide device selection in primary care. The device must be affordable for the patient, the patient must be able to handle it correctly and the practitioner or other trained professional should monitor that it is being used correctly. The patient's and physician's preferences should also be taken into account. The most important device-handling skills that should be assessed are whether the patient can: properly prepare and actuate the device; take an adequate inspiration; and coordinate actuation of a pMDI with inspiration.Testing the practicality and advantages of such checklists will mean better use can be made of the inhaler types currently available as well as newer designs. In the interim, caregiver and patient education are needed.

Assessment of rotahaler inhalation technique among patients with chronic obstructive pulmonary disease in a teaching hospital of Nepal

“…Respondents who were involved in service or outdoor works were more likely to be educated and infl uenced by others as they can see and learn from other users. Patients who had received repeated instruction and who had previously been asked to demonstrate the use of their inhaler during an instruction session were more likely to demonstrate correct inhalation technique consistent to our fi ndings, however; in current study we didn't obtain signifi cant association of inhalation technique and instruction at follow up visits as in other studies 22,23 . Correct inhalation technique wasn't affected by gender, demonstration of technique, duration of use, and teaching at follow up visits.…”

Global strategy for asthma management and prevention: GINA executive summary

“…Different inhaler devices can be demonstrated and the person with asthma encouraged to participate in the decision as to which is most suitable for them. Criteria for the initial selection of inhaler device include device availability and cost, patient skills, and preferences of the health professional and patient [142,223,224]. Patients should be given adequate opportunity to express their expectations of both their asthma and its treatment.…”

Misuse of Inhalation Devices-Effective Parameters and the Role of Education

“…Piyasada bulunan inhaler cihazlardaki çeşitlilik de göz önüne alındığında, bu cihazların doğru kullanımını hastalara tarif etmek, hekimlere fazladan iş ve zaman yükü getirmektedir. Bu durumun sonucu olarak; hastalara yeterli veya hiç inhaler cihaz eğitimi verilmemesi, hastanın bilişsel veya fiziksel yetersizliği, hastaya uygun olan cihazın seçilmemesi, eğitim ve sosyokültürel seviye farklılıkları gibi nedenlerle inhaler tedaviye kötü uyum, cihazı kullanamama ya da yanlış kullanma hastalar arasında çok yaygındır (7)(8)(9)(10)(11)(12).…”

“…İnhaler cihazı tam ve doğru kullanamama; hastalığın kontrolünün sağlanamaması veya bozulması, daha fazla ilaç kullanımı, daha fazla yan etki, sık akut atak geçirme ve hastane yatışının fazla olması, ilaç israfı gibi sonuçlar doğurarak, hem tedaviye güveni sarsmakta hem de ülkelerin sağlık harcamalarına fazladan yük getirmektedir (8)(9)(10)(11)(12)(13).…”