Changing Inhalers Does Not Cause Worse Technique

Poor inhaler technique in asthma and chronic obstructive pulmonary disease (COPD) patients does not stem from recent inhaler device changes, researchers have found.

In a study published at the 2017 Annual CHEST Meeting in Toronto, ON, CA, researchers from the University of Calgary, AL, CA, and University of London, London, UK, reported that the prominence of inhaler device misuse does not correlate with the growing options of inhalers.

“Poor inhaler technique is linked to reduced asthma control, increased hospitalizations, and exacerbation rates,” researchers wrote. “Unfortunately, inhaler technique errors are common and rates of poor inhaler technique have not changed despite introduction of educational strategies.”

Previous studies have linked patient aging, English as a second language (ESL), and multiple condition comorbidities as risk factors associated with poor inhaler technique.

To gauge the effect these conditions, as well as switching therapies, may have on technique, the researchers assessed 95 adult patients recently referred to the COPD and Asthma Respiratory Education Program. The patients were assessed by a certified respiratory education, with inadequate inhaler technique being marked if a critical error was identified.

The researchers found that 50 (52.6%) of newly referred patients reported inadequate technique. Another 37 (39.5%) of patients had a device switch in the previous year. Among them, previous risk factors for poor technique such as aging, vision impairment, no high school education, ESL, poor asthma control, and an increased number of devices were prevalent.

No evidence was found that would suggest a recent device switch would be associated with poor technique. On the contrary, patients with specific risks for poor technique — such as impaired vision — may benefit from a device switch.

That said, researchers noted that inhaler error remains a “critical issue in respiratory health.”

“As there are increasing numbers of devices available, patients are more likely to have a new device to learn,” researchers wrote. “Further research to understand that role device selection to improve patient technique is needed.”

The researchers’ description of inhaler error rates as “unacceptably high” mirrors the prognosis of Jill Ohar, MD. In a CHEST lecture advocating for inhaler education for patients and doctors, Ohar cited a recent Europe-based study that showed more than 60% of patients were not able to perform a perfect inhalation, regardless of the device.

Ohar emphasized simplified, iterative inhalation instructions for patients, noting there is no documented “better” device for patients, but there’s clinical proof of proper device use correlating with improved conditions.

“Keep those patient factors really at the top of your mind,” Ohan said. “It’s not just the drug. It’s the drug and the device.”