Inhaler devices may seem simple to use but they are often used incorrectly by patients and healthcare professionals alike.
The least cost-effective inhaler device is the one that the patient cannot use.
In deciding which device and drug formulation to prescribe healthcare professionals should first determine the patient’s ability to use the prescribed device correctly.
Inhalation is the main route for the administration of drugs for conditions such as asthma and COPD. The advantage of administering drugs by inhaler is that the drugs are delivered directly to the site of action within the airways. The onset of action is rapid and systemic adverse effects are minimised.
In order for inhaled therapy to be effective the correct drug, at the right dose must be prescribed and the device must be used correctly. However, poor inhaler technique is common.
Inhaled medications should only be prescribed by clinicians who are competent at assessing inhaler technique, but choosing a drug and corresponding device from the large variety available is potentially confusing.
Choice of inhaler should be based on:
- Patient’s ability to use the device
- Patient’s lifestyle and circumstances.
- Patient preference
- Age, competency and physical ability
Relying on the Patient Information Leaflet as the only instructional information on the use of an inhaler is not acceptable. Full training in the use of the type of device being prescribed must be provided and the technique tested either using placebo devices, prescribed medication or specially designed airflow meters.
Healthcare professionals have a responsibility to ensure that they are appropriately trained and qualified to deliver the care they are required to provide. If you are not confident that you can accurately train patients to use their inhalers correctly you must seek appropriate training. Ask your practice to support your professional development.
Inhaler technique training is essential at the time of first prescription but is also part of ongoing respiratory care. Technique should be assessed regularly and training repeated at every review. With repeated inhaler instruction there is evidence that patient adherence improves substantially
Pharmaceutical Companies produce placebo devices/testers that can be used to support technique training. Contact your local pharmaceutical representative to obtain placebo devices to use with patients.
A number of instruments have been produced to support testing of inspiratory flow rate such as the In Check (Clement Clark) device, 2-Tone Trainer (Mistry Medical Supplies) MagFlo (Fyne Dynamics) Aerosol Inhalation Monitor (Vitalograph). Make sure you are competent to use the training instruments as well as the inhalers.
On this page we include links to training resources, materials and resources to support you with inhalers technique training and information on inhalers.
This opinion sheet provides information on the different formats of inhaler devices available and factors to consider in their use in primary care
Shared decision making for greener healthcare: Guidance on making safe and clinically appropriate changes to inhalers
Use of technology, coaching of soft skills and how medicine reviews can help with this
In this episode Steve Holmes and Jane Scullion discuss optimising inhaler use and inhaler therapies. They share tips and advice on selecting inhalers taking into account important factors to be considered. Have you got views on inhalers? Tell us about them at firstname.lastname@example.org