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%
BTS/SIGN 2011BTS/SIGN 2011
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
BTS/SIGN 2011BTS/SIGN 2011
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
BTS/SIGN 2011BTS/SIGN 2011
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