Inhaler use-Are we getting it right?

A large proportion of our patients at Regional Respiratory Medicine present with chronic obstructive pulmonary disease (COPD) and/or asthma.

Part of the treatment plan often includes the use of one or more inhaled medications which if taken regularly, as prescribed, using the correct technique, allow people to play an active part in symptom control and maintaining their health.

Unfortunately, optimal control may not be achieved due to incorrect technique when these devices are used.

Research summarized by the The National Asthma Council of Australia (NACA) 2008 suggests that up to 90% of patients in clinical studies demonstrated incorrect technique using a standard metered dose inhaler (MDI) or dry-powder inhalers (DPI).

Also –
Error rates increase with age and severity of airflow obstruction / disease
Most often people are not aware of technique errors
Incorrect technique is more likely when an MDI is used without a spacer
There is an increase in associated side -effects

This has the flow on effect of further exacerbations and potential side – effects.

A spacer device used with inhalers for those with asthma and COPD can help reduce some user error problems such as difficulty co-coordinating breath and actuation, as well as being unable to reach a high enough inspiratory flow rate. Other common difficulties include poor cognitive abilities, osteoarthritis (limited dexterity), inability to achieve a good seal around mouth piece and inability to understand instructions due to poor English language skills.

We know that spacers used with an MDI -
Is equal to or better than a nebulizer
Should be used with Inhaled Cortico Steroids
Increases bronchodilation
Need less drug to get same effect
Cheaper to buy and maintain
Associated with less side-effects

HOWEVER, we still be must be aware of the potential problems with this mode of delivery.

Common mistakes made include –
Inadequate lip seal around mouthpiece
Time delay between delivering dose and inhalation (the dose stays suspended for only a short time in the spacer device and a portion of the medication ends up on the inside walls of the device if not taken straight away)
Failure to shake medication for initial/subsequent doses
Failure to wait one minute between doses
Poor spacer care and hygiene (build up of static on inner surface of spacer walls)

There is good news is from the NACA which has gathered evidence and developed guidelines to help improve asthma control. They recommend a checklist based assessment of technique followed by step by step inhaler technique. Nothing new here – the key is for this to be repeated regularly! Being shown once is not enough, as is written instructions alone.

So, expect to be asked to show us how you use your inhaler medication, even if you have been using it for years, and don’t forget to clean those spacers.

A Safe and Happy New Year to all!


Lisa

In summary, we need to be sure that each prescribed inhaler is appropriate to the individual and that they are able to use it effectively. Healthcare professionals need to be aware of the common mistakes made with each type of device and ensure their own technique is correct.