Introduction
Poor inhaler techinique is common. Choosing the best inhaler device for a patient can improve asthma control by ensuring the medicine is getting to the right place in the airways.
Patient should be asked, “show me how you use your inhaler?” Patients who tend to take a quick and deep breath in, and/or don’t use a spacer device, may find a lower-carbon, Dry Powder Inhaler (DPI) more suitable for them. DPIs also have dose counters which can help patients with adherence and know when their inhaler is empty.
Many adults find DPIs easier to use than pressurised metered dose inhalers (pMDIs) because it’s easier to get the technique right. DPIs are breath-actuated and require a quick and deep breath to inhaler the powder. Most DPIs are licensed of children from the age of 6years, however some young children (under 12yrs), or people with more severe lung conditions, may find it harder to take a quick and deep breath in. Decisions should be the outcome of an individualised assessment and shared decision-making conversation.
Changing to a lower-carbon inhaler is not linked to symptoms getting worse or an increased risk of asthma attack. In other European countries, most people who need inhalers, use lower-carbon DPIs. In Sweden, for example, 13% of inhalers sales are for pMDIs, compared to 70% in the UK.
Patients who are able to use a variety of inhaler devices should be offered a choice and informed of the environmental impact of different inhaler devices. See improving asthma reviews.
All device changes should be reviewed at approximately 4-6 weeks to check suitability, disease control and inhaler technique.
Ideally patients should be on the same device type for preventer and reliever. Inhalers should be prescribed by brand name as devices are not interchangeable.
Placebo devices & checking inhalation technique
It is useful to have placebo devices for all the low carbon inhalers on your local formulary in all consulting rooms to demonstrate and check inhaler technique. These are available free of charge from pharmaceutical companies. Click here for more information.
Many people also find the inhaler training devices, which measure peak inspiratory flow, useful for both assessing which type of inhaler device is suitable and training patients to use the correct technique for their inhaler device. The Trainhaler is useful to teach the correct technique for pMDIs.
Education: Inhaler device choice
This video explains how to help your asthma patients select the best inhaler device for them.