Inhaler technique is it important?. Compton et al (2006) Review of evidence from 6 European countries ( Spain, Italy, France, Germany, Netherlands, UK)

Inhaler techniqueInhaler techniqueis it important?is it important?

Compton et al (2006)Compton et al (2006)

Review of evidence from 6 European Review of evidence from 6 European countries ( Spain, Italy, France, Germany, countries ( Spain, Italy, France, Germany, Netherlands, UK) foundNetherlands, UK) found

Up to 50% of patients are unable to take Up to 50% of patients are unable to take their inhaler correctlytheir inhaler correctly

Up to 40% of children make errors even with Up to 40% of children make errors even with a spacera spacer

BTS/SIGN 2011BTS/SIGN 2011

Proportion of patients making no mistake Proportion of patients making no mistake with their inhalerwith their inhaler

MDI 23-43%MDI 23-43%

DPI 53-59%DPI 53-59%

MDI and spacer 55-57%MDI and spacer 55-57%


Teaching inhaler technique however Teaching inhaler technique however improved the score improved the score

MDI from 23-43% to 63%MDI from 23-43% to 63%

DPI from 55-57% to 75%DPI from 55-57% to 75%

BTS/SIGN 2011 BTS/SIGN 2011

Recommend Recommend

Prescribe inhalers Prescribe inhalers only afteronly after patients have patients have

received trainingreceived training in the use of the device in the use of the device

And have And have demonstrated a satisfactory demonstrated a satisfactory techniquetechnique

BTS/SIGN Guidelines 2012BTS/SIGN Guidelines 2012

In stable asthma (B2 agonists)In stable asthma (B2 agonists)

Children aged 5-12 pMDI & Spacer are as Children aged 5-12 pMDI & Spacer are as effective as any other inhalereffective as any other inhaler

In adults pMDI & Spacer are as effective as In adults pMDI & Spacer are as effective as any other hand held inhaler but patients may any other hand held inhaler but patients may prefer some types of DPIprefer some types of DPI

NICE guidelines on inhalers in NICE guidelines on inhalers in children (2002)children (2002)

Tell us the importance of ensuring Tell us the importance of ensuring the child is able to use the device the child is able to use the device

effectively and consider the effectively and consider the portability of the device portability of the device

BTS/SIGN Guidelines 2012BTS/SIGN Guidelines 2012

Inhaled steroids in stable asthmaInhaled steroids in stable asthma

Children aged 5-12 pMDI & Spacer is as Children aged 5-12 pMDI & Spacer is as effective as any DPIeffective as any DPI

In adults pMDI & Spacer is as effective as In adults pMDI & Spacer is as effective as any DPIany DPI


Children under 5 Children under 5

MDI and spacerMDI and spacer

And in under 2 use MDI spacer And in under 2 use MDI spacer and face maskand face mask

BTS/SIGN 2011BTS/SIGN 2011Care of spacersCare of spacers

Spacer should be compatible with the inhalerSpacer should be compatible with the inhaler

Administer in single actuationsAdminister in single actuations

Minimal delay between actuation and inhalationMinimal delay between actuation and inhalation

Tidal breathing is as effective as single breathsTidal breathing is as effective as single breaths

Spacers should be cleaned monthly rather than weekly Spacers should be cleaned monthly rather than weekly ( manufacturers recommendation ) as this reduces the effectiveness ( manufacturers recommendation ) as this reduces the effectiveness

Should be washed in detergent not rinsed and allowed to air dryShould be washed in detergent not rinsed and allowed to air dry


Adolescents with asthma prescribed MDI Adolescents with asthma prescribed MDI and spacer do not use the spacer as they and spacer do not use the spacer as they feel they are too inconvenientfeel they are too inconvenient

Adolescents inhaler choice should be Adolescents inhaler choice should be considered to improve adherence to considered to improve adherence to treatmenttreatment

BTS/SIGN 2011BTS/SIGN 2011 The choice of drug may be determined by the choice of drugThe choice of drug may be determined by the choice of drug

If the patient is unable to use the device satisfactorily an If the patient is unable to use the device satisfactorily an alternative should be foundalternative should be found

The patients ability to use their inhaler should be assessed The patients ability to use their inhaler should be assessed by a competent health care professionalby a competent health care professional

The medication needs to be titrated against clinical response The medication needs to be titrated against clinical response

to ensure optimum efficacyto ensure optimum efficacy

Reassess inhaler technique as part of a structured clinical Reassess inhaler technique as part of a structured clinical reviewreview

GINA 2009GINA 2009

Poorly controlled asthma is expensivePoorly controlled asthma is expensive

Ensuring adequate effective preventer Ensuring adequate effective preventer medication will give cost savingsmedication will give cost savings

ThereforeTherefore

The The cheapestcheapest inhaler is inhaler is one the patient one the patient cancan and and

willwill take take

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Inhaler technique is it important?. Compton et al (2006) Review of evidence from 6 European countries ( Spain, Italy, France, Germany, Netherlands, UK)