Optimising inhaler technique in chronic obstructive pulmonary disease: a complex issue

Abstract

Inhaled therapies play a central role in the management of chronic obstructive pulmonary disease (COPD); however, studies indicate that many patients do not use their inhaled medication as directed, resulting in decreased medication delivery and suboptimal disease control. Key factors that should be considered when evaluating whether patients are achieving optimal outcomes with inhaled therapies are: if patients are using a correct inhalation technique; if patients have adequate dexterity to use the prescribed inhaler; if patients have sufficient inspiratory flow rate to achieve adequate lung deposition (for dry powder inhalers); and if the inhaler is accepted by the patient. There are many different types of dry powder inhalers available for COPD medications and their specific features can affect ease of use and suitability and acceptability for individual patients and patients' preferences.

Management of the pharmacological treatment in patients with chronic obstructive pulmonary disease

“…In our study, although the participants feel competent to comply with the prescribed treatment, when reporting the steps on the use of inhalers, only two patients demonstrated complete knowledge about the inhalation technique and the rest of the participants presented errors in more than one of the steps. In other words, the effectiveness of the inhalers is low in the overwhelming majority of the participants, as shown by multiple studies (Bryant et al, 2013;Price et al, 2018;Riley & Krüger, 2017). We should remark that one of the participants who reported the technique more correctly had the highest level of schooling.…”

“…There are several errors identified in the implementation of the inhalation technique, namely: wrong inspiratory flow; non-compliance with the time of inhalation; poor coordination between inhalation and administration; errors in the preparation of the dosage, in forced expiration before inhalation, and in suspension of breathing during inhalation (GOLD, 2018). The incorrect use of inhalers is associated to the aggravation of symptoms and of the clinical condition (Melani & Paleari, 2016;Riley & Krüger, 2017). However, the demonstration of the inhalation technique by health professionals, followed by training by patients, proved to be effective in acquiring skills for the self-administration of inhalers (Hickey et al, 2017;Price et al, 2018).…”

General Practitioner Use of Generically Substitutable Inhaler Devices and the Impact of Training on Device Mastery and Maintenance of Correct Inhaler Technique

“…While the primary aim of this study was to evaluate intuitive IT, which is not necessarily impacted by feedback mechanisms, it is foreseeable that this feedback mechanism could influence participant preference. Research indicates that feedback mechanisms can impact user device preference in both a positive and negative way [3,45,60,61]. ''Taste'' (such as that associated with the deposition of lactose in the mouth) is a polarizing feature that can sometimes be associated with a decreased preference for a device but can also be a feature associated with increased preference due to the feedback feature [47].…”

Making COPD Self-Management Education Work

“…4,7 The number of people who correctly use inhalers improved when providers and patients received adequate education. 8 Inhaler assessments need to be conducted by a skilled individual 4,8 and reassessed at regular intervals. 4,6,8 The challenge arises when health care providers are not adequately trained and there is insufficient time for education.…”

“…8 Inhaler assessments need to be conducted by a skilled individual 4,8 and reassessed at regular intervals. 4,6,8 The challenge arises when health care providers are not adequately trained and there is insufficient time for education. 8 One third of respondents with COPD indicated a lack of time for discussing their condition, and more than half of participants did not recall receiving training on their devices on their first visit.…”