Inhaler technique in older people in the community

Ho, Shu Fang; O'Mahony, M Sinead; Steward, John; Breay, P; Burr, Michael Leslie

doi:10.1093/ageing/afh062

Cited by 68 publications

(57 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Correct inhaler technique is essential for the most effective delivery of inhaled drugs; however, a number of studies have identified that errors in inhaler technique are common [2, [12][13][14][15]. Errors in inhaler technique are associated with suboptimal delivery of the drug into the lungs and may also potentially increase the risk of adverse effects, particularly with inhaled corticosteroids, but despite this, one study demonstrated that approximately a fifth of older patients receiving inhaled therapy could not recall receiving inhaler technique training [16].…”

Section: Reviewmentioning

confidence: 99%

“…In a UK based study of people over the age of 70 years living at home, 15.8% of subjects were using an inhaler, of whom 42.8% were using a metered-dose inhaler (MDI) [16]. Despite their wide prescription many patients cannot use pMDIs correctly, even with education and training [13,18,19].…”

Section: Pressurized Metered-dose Inhalersmentioning

confidence: 99%

“…Spacers achieve this by reducing aerosol particle velocity due to the spray encountering air resistance, and a reduction in aerosol particle diameter due to evaporation. The use of a spacer device has long been recognized to improve the inhalation of drugs from pMDIs, particularly for patients with difficulty using a pMDI alone [16,23]. The use of a spacer in combination with a pMDI may reduce the risk of adverse side effects, particularly in relation to the use of high-dose inhaled corticosteroids [24].…”

Section: Pressurized Metered-dose Inhalersmentioning

confidence: 99%

“…Lenney et al found that 91% of patients had good inhaler technique with the Easi-Breathe ® (IVAX, UK) inhaler device after expert training and was by far the most popular inhaler device of seven devices tested, including the pMDI, pMDI plus Volumatic ® spacer (GlaxoSmithKline, UK), Accuhaler ® (GlaxoSmithKline, UK) and Turbohaler ® (Astrazeneca, Sweden) [15]. In a later study by Ho et al BA-MDIs were only found to be used correctly by 72% of individuals [16]. An important consideration for the use of BA-MDIs is the need for the patient to be able to generate sufficient inspiratory flow to trigger the delivery of the aerosol.…”

Section: Breath-actuated Metered-dose Inhalersmentioning

confidence: 99%

See 3 more Smart Citations

Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma

Capstick

Clifton²

2012

Expert Review of Respiratory Medicine

117

View full text Add to dashboard Cite

Section: Reviewmentioning

confidence: 99%

Section: Pressurized Metered-dose Inhalersmentioning

confidence: 99%

Section: Pressurized Metered-dose Inhalersmentioning

confidence: 99%

Section: Breath-actuated Metered-dose Inhalersmentioning

confidence: 99%

See 2 more Smart Citations

Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma

Capstick

Clifton²

2012

Expert Review of Respiratory Medicine

117

View full text Add to dashboard Cite

“…However, another study [78] aimed at comparing MDIs with large volume spacers with breathactivated inhalers and DPIs in the elderly demonstrated that the latter were more likely to be used correctly than inhalers with large volume spacers. Despite some of the above-reported evidence and the generally accepted view that older people use conventional MDIs poorly, MDIs seem to be the most frequently employed type of inhaler device amongst older people in the community, and are used adequately when in combination with large volume spacers [79]. However, this study excluded patients with cognitive impairment, likely underestimating the rate of failure to use inhalers properly in the community.…”

Section: Practical Considerations For Elderly Patients On Long-term Dmentioning

confidence: 91%

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

et al. 2015

View full text Add to dashboard Cite

Inhaled corticosteroids (ICSs) are widely used in the treatment of patients with chronic obstructive pulmonary diseases. However, high-dose regimens and longterm use of ICSs have the potential to cause a variety of local and systemic side effects such as candidiasis, cataracts, glaucoma, and osteoporosis. The use of ICSs can also be associated with the risk of bone fractures, diabetes mellitus and pneumonia. These ICS-related side effects are of particular importance in elderly patients due to the presence of comorbidities and age-related behavioral, cognitive, and psychological problems, which can all interact with inhaled treatment. We reviewed the available literature on the clinically relevant side effects of ICSs in the elderly to provide practical measures to properly monitor and manage the risk of ICSs in the geriatric population. Inspection of the mouth, monitoring of ocular pressure, and use of bone-protective drugs may be necessary in patients on prolonged ICS therapy. Above all, the use of the lowest possible ICS dose and a careful re-assessment of the inhalation procedure should be recommended. Taken together, these observations suggest that physicians should use ICSs appropriately for those patients in whom the benefit will outweigh the risk, especially chronic obstructive pulmonary disease (COPD) patients with previous frequent exacerbations. Given the paucity of information on the topic and the need to extrapolate the results from studies with broader age ranges, we strongly encourage the design of specifically tailored clinical studies in the elderly. Key PointsAsthma and chronic obstructive pulmonary disease (COPD) are inflammatory disorders of the airways. The pharmacological management of these chronic diseases is based on persistent and long-term use of inhaled corticosteroids (ICSs).Asthma and COPD are among the most common chronic diseases in clinical settings, and physicians are expected to diagnose and manage those diseases in the geriatric population on a daily basis. The management of chronic obstructive respiratory diseases in the geriatric population is complicated by the increased occurrence of comorbidities and associated treatment, and by age-associated physiological and structural changes of the lung.The chronic use of ICSs in the elderly is associated with the increased risk of local and systemic side effects such as candidiasis, cataract, glaucoma, diabetes mellitus, bone fractures, and pneumonia. Physicians should be aware of this in order to select those patients in whom the benefits will outweigh the risks.The online version of the original article can be found under

show abstract

Pharmazeutische Anwendungshilfen in der Gerontopharmakologie

Kircher

2012

Internist

View full text Add to dashboard Cite

The administration of drugs is often subject to error when performed by geriatric patients, resulting in reduced therapeutic effects. In particular, the correct administration technique for different dosage forms is a problem in elderly patients with limited audiovisual and ergonomic abilities. In addition to physician and carer intervention, community pharmacists can also contribute to solving outpatient problems of this kind at the time of issuing the drugs. This should preferably be done in collaboration with the respective medical practice. Some of the most common problems in drug administration, as well as the corresponding solutions offered by the pharmacist, are featured in the present paper. Inhalers, injection devices and ophthalmic solutions often cause difficulties for geriatric patients, as do even simple dosage forms such as drops. Pharmacy-based solutions to these problems include for instance: taking over the assembly of complex devices comprising multiple components, instructing patients in the proper use of additional dosing aids or adapting the administration technique to the patient's abilities.

show abstract

Inhaler technique in older people in the community

Cited by 68 publications

References 11 publications

Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma

Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

Pharmazeutische Anwendungshilfen in der Gerontopharmakologie

Contact Info

Product

Resources

About