Respiratory diseases such as asthma and COPD (which includes bronchitis and emphysema) can be treated using medication inhaled via a wide variety of devices. The clinical effectiveness of each device is carefully studied and documented well before it is ever released to the general public, but recommendations on how best to use each device are frequently not followed by patients.
The U.K's National Asthma Campaign estimates that asthma claims the lives of about 1500 people in the UK each year and many of these deaths might have been prevented with adequate routine and emergency care. In addition, asthma annually costs the NHS £850m, the DSS £161m and the nation a staggering £1.2 billion in lost productivity. Whilst many reasons will be behind these figures, one specific problem relating to the treatment of asthma is ensuring that the patient uses their inhaler properly.
The problem is not restricted to the U.K. or Europe. Studies worldwide have found that patients rarely use the inhaler in the same way that was seen in clinical trials where great care is taken here to ensure technique is good and the device is always used optimally.
"The most common reasons for the failure of inhaled drugs are inappropriate selection, incorrect inhaler technique and lack of concordance Even those who use a device well may lapse from accurate use or develop an incorrect technique when in a stressful situation such as an asthma attack."
Linda Pearce, Respiratory Nurse Consultant, U.K.
Whilst the traditional press and breath asthma inhaler, often called a puffer, may look simple to use, the reality is that many patients inhale too fast, and at the wrong time (poor coordination).
It has also been found that users of spacers and holding chambers frequently inhale too fast for correct use of the device, reducing the benefit of using a device that helps to overcome the problems of coordination.
Even the more recently introduced breath-actuated inhalers (which overcome the problems of coordination by automatic drug release) are often used incorrectly.
Dry powder inhalers, where the problem of coordination is greatly reduced, are frequently relied upon by patients who fail to inhale at a sufficiently high enough speed to optimise the efficiency of the device - the resulting drug delivery to the lungs is reduced.
Patient education
It has been accepted that the education of patients about correct device use, and regular check-up of inhaler technique, are both fundamental in improving overall care. Asthma guidelines in the United Kingdom encourage regular monitoring of inhaler technique, and the new employment contract (2003) for General Practitioners rewards those who monitor inhaler technique in COPD, so it is likely that patients are likely to benefit from an increased awareness amongst professionals of the value in correct inhaler use. For those patients who actively seek additional help outside their own Doctors care, the Internet and self-help groups are increasingly providing useful educational information.
Professional education
To ensure patients receive correct and up-to-date training on how to use their inhaler requires that the professionals themselves are educated to a high enough standard, and have sufficient time to teach the patient during a consultation. Training courses on respiratory diseases are available, and the better courses allocate time to deal with teaching of inhaler technique; however, on return to clinical practice, the limited time available often results in patients receiving little or poor information on how to use their medication device.
Health Professionals with an interest in respiratory medicine have recognised that without improving training for themselves, they will be unable to improve the overall care of the patient. Their research has confirmed that many of their colleagues cannot demonstrate good inhaler technique when asked to do so.
The introduction of the In-Check inspiratory flow meter has allowed researchers to accurately measure the speed of inhalation of both patients and professionals, revealing frequent failure to demonstrate or use devices at the recommended inspiratory flow rate. It is likely that poor perception of what is a fast or slow inhalation is to blame after all, air is invisible, and without accurate measurement instruments, professionals have only been able to guess how quickly people breathe in.
Downloads
| ATS poster.pdf | |
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Description : Do Health Professionals Have Sufficient Knowledge And Skill To Teach Optimum Inspiratory Flow (OIF)? A Study Using The In-Check Dial (ICD) To Evaluate Inspiratory Technique Poster presented at American Thoracic Society meeting, June 2001. PDF file. |
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| ERS summary.pdf | |
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Description : Research conducted at the European Respiratory Society meeting, Vienna 2003. ERS Summary 5th November 2003. PDF file. |
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Peak inspiratory flow through diskus and turbuhaler, measured by means of a peak inspiratory flow meter (In-Check DIAL). van der Palen J. Respir Med. 2003 Mar;97(3):285-9.
(An electronic reprint of this paper is available on request send us your email address by clicking HERE, and putting Van Der Palen in the heading)
Weblinks
National Asthma Campaign
Gender Differences in Metered-Dose Inhaler-Spacer Device Techniquehttp://www.medscape.com/viewarticle/409642_1
Physicians metered dose inhaler technique after a single teaching session
http://allergy.edoc.com/1996_archives/pdf/feb_96/145.pdf
Metered-dose inhaler technique among healthcare providers practicing in Oman
http://www.squ.edu.om/mj/Apr2001/metr_dose/meterdose.pdf
Assessment of Metered Dose Inhaler Technique in Family Health Service Patients in Singapore
