Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability

Abstract

Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. V. Giraud, N. Roche. #ERS Journals Ltd 2002. ABSTRACT: This study assessed whether the improper use of pressurized metereddose inhalers (pMDIs) is associated with decreased asthma control in asthmatics treated by inhaled corticosteroids (ICS).General practitioners (GPs) included consecutive asthmatic outpatients treated by pMDI-administered ICS and on-demand, short-acting b 2 -agonists. They measured an asthma instability score (AIS) based on daytime and nocturnal symptoms, exerciseinduced dyspnoea, b 2 -agonist usage, emergency-care visits and global perception of asthma control within the preceding month; the inhalation technique of the patient also was assessed.GPs (n=915) included 4,078 adult asthmatics; 3,955 questionnaires were evaluable. pMDI was misused by 71% of patients, of which 47% was due to poor coordination. Asthma was less stable in pMDI misusers than in good users (AIS: 3.93 versus 2.86, pv0.001). Among misusers, asthma was less stable in poor coordinators (AIS: 4.38 versus 3.56 in good coordinators, pv0.001).To conclude, misuse of pressurized metered-dose inhalers, which is mainly due to poor coordination, is frequent and associated with poorer asthma control in inhaled corticosteroid-treated asthmatics. This study highlights the importance of evaluating inhalation technique and providing appropriate education in all patients, especially before increasing inhaled corticosteroid dosage or adding other agents. The use of devices which alleviate coordination problems should be reinforced in pressurized metered-dose inhaler misusers.

Inhaler technique: does age matter? A systematic review

“…The included studies were published between 1979 [20] and 2015 [25], with samples ranging from 59 [7] to 3995 [4] participants, and ages ranging from 6.1 years [24] to older adulthood. Age thresholds for older adults varied between investigations.…”

“…Studies differed according to methodology, with 10 employing an observational, cross-sectional methodology [4,5,7,[19][20][21][22][23][24][25], one an observational, comparative, cohort methodology spanning 18 months [26], one a comparative, cross-sectional methodology employing a community intervention [27], one a comparative, cohort study employing a community intervention spanning 4 weeks [28], and one employing a randomised-controlled-trial cohort design spanning 6-10 weeks (supplementary table S2) [29].…”

“…However, although healthcare professional-coordinated inhaler technique training can improve asthma control [2,3], inhaler technique remains a significant problem. From the currently available data, across all ages, as many as 90% of patients are estimated to demonstrate incorrect technique [4], contributing to increased hospitalisations [5] and forfeiture of billions of dollars in pharmaceutical expenditure [6]. An otherwise vulnerable population, the elderly, are particularly at risk, on account of increased evidence of cognitive and physical disorders affecting their ability to emulate and retain required skills [7,8].…”

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

“…In one study of 4078 adults with asthma treated with inhaled corticosteroids delivered by pMDI, poor technique was identified in 71% of patients. Asthma stability was found to be worse in patients with poorer inhaler technique (as determined by the number of errors made in their inhaler technique), than patients with good inhaler technique [57].…”

Which factors affect the choice of the inhaler in chronic obstructive respiratory diseases?

“…Their correct use requires coordination between inhalation and device actuation. Incorrect technique can limit the effectiveness in daily clinical practice; lack of coordination can occur with pMDIs and represents almost half of all errors [4]. This can lead to ineffective drug delivery to the lungs with excess deposition in the oropharynx.…”