The Clinical Impact of Incorrect Inhaler Use

Tonya Winders, MBA

Editor’s note: This is a column by Tonya Winders, MBA, President and CEO of the Allergy & Asthma Network. The presented analysis reflects her views, not necessarily those of the publication.

Health care professionals and researchers interested in responding to this piece or similarly contributing to MD Magazine® can reach the editorial staff by submitting a request here.

Proper diagnostics is key in healthcare, but patient education on management and medication use can lead to empowerment that unlocks optimal health outcomes. This is vitally important in helping patients use inhaled medications—both pressurized metered dose (pMDI) and dry powder inhalers (DPI).

When used correctly, asthma inhalers deliver the medicine right where it is needed: inflamed and congested airways. But the medicine will be ineffective if it doesn’t get to the source of the issue: the lungs.

Healthcare providers and patients have to administer the medication correctly; the force of the spray won’t compensate for errors in administration.

A review of the recently published article, “Errors in the Use of Inhalers by Health Care Professionals: A Systemic Review” by V. Plaza et al., shows that as many as 85% of healthcare providers (HCPs) demonstrate a poor knowledge of the use of inhalers they prescribe for their patients.

Incorrect inhaler use was examined in 3 categories:

1. Device-related: The patient or HCP experiences difficulty using the device due to design or the complicated operation of the inhaler.

2. Patient-related: The patient demonstrates trouble understanding directions or experiences an impairment that affects device use.
3. HCP-related: The HCP has limited time with patients, is not current with new medications or lacks effective communication with patients.

The study revealed that HCPs performed correct inhaler technique half as often as patients did (15.5% versus 31%, respectively).

When administering a pMDI, the most common errors were lack of coordination, full expiration of breath and post-inhalation breath-hold. For DPI inhalers, the most common difficulties were poor preparation, full expiration of breath and lack of breath-hold.

HCPs in the study included general practitioners, internal medicine specialists, pulmonary specialists, pediatricians, medical residents, medical students, medical assistants, respiratory therapists, nurses and nursing students, as well as pharmacists, pharmacy students and technicians.

Correct inhaler technique by HCPs is vitally important to provide patients with the accurate information and to ensure proper medication delivery for their respiratory issues.

HCPs who do not display correct inhaler technique may hinder their patients’ education and know-how when using their prescribed inhaler. Specific and continuous educational training programs for HCPs will improve training skills and lead to more patients using their inhalers correctly.

Every HCP should be well-versed in demonstrating, educating and coaching proper usage of these devices to patients and be aware of the many types of devices available and how they function.

They must communicate and educate each other as well as patients.

HCPs and patients should review inhaler
technique at each appointment. Hands-on learning and return demonstration using an inhaler under supervision is
ideal, so that the provider can give
immediate feedback. Technique can be
evaluated and reinforced at each visit. Video demonstrations can also be a helpful tool between visits.

HCPs should provide written instructions in simple, easy-to-understand steps. They should also encourage the use of valved holding chambers with MDIs as so many people, especially children, have difficulty coordinating spray with inhalation.

HCPs, in partnerships with their patients, can demonstrate optimal inhaler technique to empower their patients and families to strive for an increased and robust lifestyle.

Resources for Improving Inhaler Technique

Allergy & Asthma Network

Centers for Disease Control & Prevention: Know How to Use Your Asthma Inhaler