Lung disease patients still don’t use inhalers properly

Researchers have found that patients’ use of inhalers has not improved for 40 years, prompting an “urgent” need for new approaches to education and drug delivery. 

The researchers undertook a systematic review of literature published between 1975 and 2014 about inhaler use and the most common errors of technique involving metered-dose inhalers (MDI) and dry powder inhalers (DPI). 

Publishing their findings in the August 2016 issue of Chest
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, the authors found that only 31% of patients diagnosed with asthma or chronic obstructive pulmonary disease (COPD) used their inhalers correctly, another 41% had “acceptable” technique and 31% had “poor” technique. 

“We saw no indication that the problem of incorrect or suboptimal use had diminished over the past 40 years, even though considerable effort has been invested in education, training, and device development,” they say. 

Led by Joaquin Sanchis from the department of pneumology at Hospital de Sant Pau in Barcelona, the team analysed 144 articles involving 54,354 patients from 31 countries and 59,584 observations of patient inhaler technique. 

They found the most frequent MDI errors were linked to coordination (45%; 95% confidence interval, 41–49%), speed and/or depth of inspiration (44%; 40–47%), and no post-inhalation breath-hold (46%; 42­–49%). 

Looking at DPIs, the researchers found incorrect preparation in 29% of cases (26–33%). There was no full expiration before inhalation in 46% of cases (42–50%), and no post-inhalation breath-hold in 37% of cases (33–40%). 

The authors believe their findings of “persistently high error rates” are “robust and clinically important”, adding that incorrect inhaler use by asthma patients in particular may be a “major obstacle” for achieving good disease control.

Toby Capstick, lead respiratory pharmacist at St James University Hospital in Leeds, says the study confirms what many healthcare professionals have suspected for a long time – that poor inhaler technique continues to be a major issue in patients with lung diseases.

He says correcting and optimising poor inhaler technique is a “key intervention” for all healthcare professionals and adds that “pharmacists are well placed to check and optimise inhaler technique regularly, whether in clinics, community pharmacy or during hospital admissions”.

“It is therefore important that healthcare professionals understand how to use any inhaler they prescribe or dispense in order to ensure the patient can also use it,” Capstick adds.

“Unfortunately studies show that healthcare professionals also commonly make errors using inhalers. As these studies include pharmacists, understanding inhaler technique is a critical CPD requirement for all clinical pharmacists.

“These data suggest that there remains an unmet need for simpler, easier to use inhaler devices,” he says.