Technique training does not improve the ability of most patients to use pressurised metered-dose inhalers (pMDIs)

Abstract

Aims: According to guidelines, inhaler technique should be tested in all patients, particularly those with poorly controlled asthma. We aimed to assess uncontrolled asthma patients' ability to use a pressurised metered-dose inhaler (pMDI) using the Aerosol Inhalation Monitor (AIM, © Vitalograph).Methods: Practices invited patients for a detailed clinical review by trained asthma nurses according to practice-agreed protocols. Reviews took place from 1st April to 30th June 2008, and included checking of inhaler technique. Reasons for invitations included time since last review, asthma control, prescriptions, and adherence to medical advice. A proxy measure of control -the total number of short-acting β2-agonist (SABA) bronchodilator inhaler canisters prescribed in the previous 12 months -was used. Data on 77 pre-determined clinical parameters (including prescribing and healthcare utilisation data) were collected. Patient-completed postal symptom questionnaires (the RCP 3 questions) were obtained in some patients. All patients using pMDIs had at least two assessments using the AIM, and where appropriate inhaler technique education was provided.Results: 2123 (24% of those invited) symptomatic asthma patients were reviewed; 1291 (61%) were using pMDIs (mean age 52 years; SD 21), of whom over 80% were in BTS/SIGN Steps 2 and 3. 1092 (85.6%) of those patients using pMDIs failed the first AIM assessment. There was a significant increase in the number of patients able to use their pMDIs correctly following instruction after the second (129 to 260 of 1197 patients, p<0.01) and third (61 to 181 of 528 patients, p< 0.01) tests. However, 78.4% and 65.7% of those tested twice and three times, respectively, failed the AIM assessment despite instruction. Logistic regression analysis failed to show any effect of age and BTS step on these outcomes.Conclusions: A majority of symptomatic asthma patients in this study were unable to use pMDIs correctly. It is essential to check all patients' ability to use their prescribed inhalers regularly. Cost alone should not determine prescribing recommendations.

Study on Utilization Pattern of Pulmonary Inhalers in Inpatient, Bhagwan Mahaveer Jain Hospital, Bangalore, India

“…[8] Most patients with asthma or chronic obstructive pulmonary disease (COPD) require drug treatment with inhalation the major route of administration. The majority of asthma and COPD patients use their pressurised metered-dose inhaler (pMDI) incorrectly [2,6]. Major reasons for this are failure by patients to coordinate actuation with inhalation and failure to use a slow and deep inhalation [1, 2, and 6].…”

Impact of educational intervention on pressurized metered dose inhaler technique among undergraduate medical students

“…These findings are consistent with previous studies, wherein a structured educational demonstration achieved a better result compared to provision of instruction pamphlets. 16,17 In these studies methods used included hand-outs, videotapes on correct inhaler technique and hands on experience with placebo inhalers and assessments were repeated at one to three months after the education was delivered and results showed significant improvement in inhaler technique in the majority of studies. 18 One month after the intervention, participants didn"t show significant improvement in inhaler technique by demonstration method ,when compared with baseline and 1 week post intervention scores.…”

Patient Education and Adherence to Aerosol Therapy

“…The reported prevalence of incorrect inhalation technique varies from 4 to 94%. 10,[24][25][26][27] There are many reasons behind incorrect inhalation technique. Patients may be confused with devices requiring different inhalation techniques or have difficulty using their aerosol devices correctly.…”