Inhaler devices for asthma: a call for action in a neglected field

Real-world asthma management with inhaler devices in Switzerland—results of the asthma survey

“…In addition, patients do express preference for particular inhaler devices, which makes successful teaching easier (32,33). On the other hand, in D-CH, pMDI prescriptions were significantly more often triggered by patient age and by the presence of a low inspiratory flow than in W-CH, which is consistent with more technically objective reasons for prescribing and with the recommendation that choice of device should be based on the individual patient's natural inhaler technique, preferring an MDI in patients who naturally tend to breathe in slowly and preferring a DPI in those who tend to inspire hard and fast (7,11). The Swiss healthcare system is identical in all linguistic regions, basically consisting of a compulsory health insurance which covers all costs related diagnostic and therapeutic measures, including for all chronic airway diseases.…”

“…It is also likely that Swiss physicians almost systematically add the second layer of patient education/information reported in this survey as an anticipatory response to this perceived lack of efficiency. It has been repeatedly shown that health care providers (across all disciplines) often do not sufficiently master the inhalation technique themselves (7,11,18,19) and are not sufficiently aware of device-specific handling difficulties, even more so in an increasingly complex environment with a steadily growing inhaler diversity (11,13,(20)(21)(22). In this context, the best person to provide inhaler training should be the one with the appropriate skills, adequate time, and access to teaching resources.…”

“…Patient education provided by health care professionals (physicians, but also pharmacists or nurses) with regard to the disease and to handling of the device has repeatedly been shown to be of crucial importance (8)(9)(10). While drug choice is usually the first step when prescribing an inhaled therapy, some have argued that choice of the inhaler device may be even more important (11,12). The available inhaler devices share common potential sources of handling errors.…”

Randomized controlled trials and real life studies. Approaches and methodologies: a clinical point of view.

“…This may be due to differences in education on inhaler handling and in the choice of the most suitable inhaler for each patient [14,84]. RCTs and guidelines do not ascribe differences in clinical outcomes to inhalers [14,17,19,85e87], possibly because patients in RCTs are adequately instructed in the proper use of their devices [14,88]. Conversely, differences emerge from real life studies, particularly in asthma, one of the first clinical conditions in which inhaler technique was investigated.…”

Fluticasone propionate/formoterol: A fixed-combination therapy with flexible dosage

“…Indeed, there is evidence to indicate that a combination of suboptimal use of available drugs, poor adherence to treatment and misjudgment of the level of asthma control by physicians and/or patients, contributes to unsuccessful disease control. Possibly this is also due to poor inhaler technique, a variety of unintentional nonadherence, which is widespread and neglected in asthma [14]. Two main types of inhaler devices are currently available for drug lung delivery in asthma, metered dose inhalers (MDIs) and dry powder inhalers (DPIs).…”