Inhaler technique training with regular checks and assessment needs to be an integral part of the routine management of any patient with COPD. Incorrect inhaler technique is common among patients with asthma or COPD. In COPD, this could result in suboptimal disease control, raising the risk of absences from work. Unnecessary increases in medication dosage, exacerbations requiring oral corticosteroid treatment, and potential side-effects.
Inhaler technique training needs to be undertaken by a healthcare professional proficient in providing inhaler technique training. There is evidence that the training is not always delivered by appropriately trained staff. The training could be delivered by a wide variety of healthcare professionals, including medical staff, nursing staff and pharmacists, depending upon the individual practices. It should not be simply assumed that all healthcare professionals have perfect inhaler technique.
Inhaler technique is particularly common among older people with COPD, whether using a pMDI or a DPI. Some older patients with advanced COPD may bene?t from the use of a spacer with a pMDI. However, many will also have difficulties connecting the inhaler to the spacer. Breath-activated inhaler (e.g. Autohaler) may be easier to use for some older patients.
Patients with osteoarthritis may be unable to activate a pMDI easily, and may bene?t from the use of a breath-activated inhaler. Mechanical difficulties can usually be overcome by checking each individual’s technique and helping the person identify which inhaler they can use best.
Most patients with COPD are unable to use a pMDI correctly. Common errors include inadequate coordination of inspiration and actuation and inability to achieve a high enough inspiratory ?ow rate. Even with training, some will be unable to overcome these problems and may do better with a pMDI plus spacer.
A study using Accuhaler and Turbuhaler showed that patients with severe COPD were less likely to achieve a high enough inspiratory rate to activate the inhaler, even after instruction. These patients might achieve better technique using a breath-activated inhaler, where possible. Adequate lung doses of ICS may be achieved with a breath-activated inhaler, despite poor technique.
Source: www.nlm.nih.gov