O5. Inhaler technique and adherence

O5.1 Inhaler technique

Inhaler devices must be explained and demonstrated for patients to achieve optimal benefit. It is necessary to check regularly that the patient has the correct inhaler technique. Elderly and frail patients, especially those with cognitive deficits, may have difficulty with some devices. Correct inhaler technique is essential for the optimal use of all inhaled medications (Melani 2011) [evidence level I]. Ease of operating and dose preparation were rated as being the most important inhaler features leading to higher patient satisfaction and fewer critical errors in a randomised, open-label, multicentre, cross-over study of two inhaler devices (van der Palen 2013) [evidence level II]. An Australian cross-sectional study found that the proportion of patients with COPD who made at least one error in inhaler technique ranged from 50% to 83%, depending on the device used (Sriram 2016). The Lung Foundation Australia has produced a number of “how-to” video clips instructing patients how to use their inhalers. These are available on the Lung Foundation website at http://lungfoundation.com.au/patient-support/copd/inhaler-technique-fact-sheets. Lung Foundation Australia’s resource, Better Living With COPD: A Patient Guide contains an Inhalation devices chapter which can be accessed at http://lungfoundation.com.au/wp-content/uploads/2014/02/08.-Using-your-inhalation-devices.pdf.

The cost of inhaler devices varies between products. As there are no differences in patient outcomes for the different devices, the cheapest device the patient can use adequately should be prescribed as first line treatment (NHS Centre for Reviews and Dissemination 2003). The range of devices currently available, the products and dosage, as well as their advantages or disadvantages, are listed in Appendix 2. Brief counselling; monitoring and feedback about inhaler use through electronic medication delivery devices; and multi-component interventions consisting of self-management and care co-ordination delivered by pharmacists and primary care teams have been shown to improve medication adherence (Bryant 2013) [evidence level I].

Pragmatic pharmacist care programmes may improve inhaler technique and refill adherence in patients with COPD (Tommelein 2014) [evidence level II].