Inhaler technique
Inhaler technique
Over 50 per cent of patients with COPD are not able to use their devices correctly and this suboptimal use makes the medication less effective.
A systematic review showed that the most frequent pMDI errors, made by over 40 per cent of patients, were in:
- Co-ordination
- Not doing a full expiration before inhalation
- Speed and/or depth of inspiration
- No post-inhalation breath-hold.
Incorrect preparation was also frequently observed (29 per cent). Watching a patient demonstrate how they use their inhaler face-to-face remains the preferred method of assessment, but remote consultations have increased markedly during the Covid-19 pandemic.
Seven steps that are recommended to optimise inhaler technique are:
- Prepare the inhaler device
- Prepare or load the dose
- Breathe out, fully and gently, but not into the inhaler
- Place inhaler mouthpiece in the mouth and seal the lips around the mouthpiece
- Breathe in:
– pMDI: Slow and steady
– DPI: Quick and deep - Remove inhaler from the mouth and hold the breath for up to 10 seconds
- Wait for a few seconds and then repeat as necessary.
Most patients are already familiar with telephone consultations, and these can provide an opportunity to reinforce the importance of optimal inhaler technique and enable the healthcare professional and patient to talk through their technique to identify areas or steps that require improvement. A video-enabled consultation can be helpful in improving technique with devices that patients are already familiar with or establishing that a change in device is necessary. Both video and telephone consultations can be used to identify patients who should be prioritised for face-to-face appointments.
Patients should be encouraged to look at online resources such as the patient inhaler videos hosted on the Asthma UK or RightBreathe websites. RightBreathe has the facility to send content directly to the patient’s email from its app or website by simply pressing the share information button next to the relevant treatment.
Sometimes, it may be possible to talk through the treatment on the telephone while the patient looks at the relevant RightBreathe page to help reinforce understanding and ask if they have any questions.