Section 1:

The importance of correct inhaler technique in patients with asthma

The recently updated British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) British Guideline on the Management of Asthma states that the aim of asthma management is control of the disease. Complete control is defined as:1

  • No daytime symptoms
  • No night-time awakening due to asthma
  • No need for rescue medication
  • No asthma attacks
  • No limitations on activity, including exercise
  • Normal lung function (FEV1 and/or PEF>80% predicted or best)
  • Minimal side effects from medication

To achieve early control and maintain it, patients should receive treatment at the level appropriate to the severity of their asthma, using an appropriate combination of inhaled corticosteroids (ICS) and bronchodilators.1

Inhaled medications are the cornerstone of treating asthma. The most important advantage of the inhaled route of delivery is that medications are delivered directly into the airways, resulting in higher local concentrations with lower systemic concentration and fewer systemic side effects compared with oral or intravenous routes.2

Unfortunately, inhalation can be complicated and difficult for many people, reducing the effectiveness of their inhaled therapy.2 Poor inhaler technique leads to poor asthma control, increased risk of exacerbations and increased adverse effects.3

While estimates of the prevalence of errors in inhaler technique vary, the latest report from the Global Initiative for Asthma (GINA) states that most patients – up to 70-80% – are unable to use their inhaler correctly.3

In a systematic review from 2016, only 31% of patients were found to be using their inhalers correctly.4

According to BTS/SIGN, the proportion of patients making no mistakes with an inhaler was 23-43% for a pressurised Metered Dose Inhaler (pMDI), 53-59% for a dry powder inhaler (DPI), and 55-57% for pMDI + spacer. When technique was assessed as the number of steps carried out correctly, out of the total number of steps, pMDI + spacer was slightly better than DPI.1

Job code: UK/RES-19014d DOP: April 2020

References

  1. British Thoracic Society/Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma, 2019. https://www.sign.ac.uk/sign-158-british-guideline-on-the-management-of-asthma.html [Accessed April 2020]
  2. UK Inhaler Group. Inhaler Standards and Competency Document. https://www.respiratoryfutures.org.uk/media/69774/ukig-inhaler-standards-january-2017.pdf [Accessed April 2020]
  3. Global Initiative for Asthma. Global strategy for asthma management and prevention, updated 2019. https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf [Accessed April 2020]
  4. Sanchis J, Gich I, Pedersen S. Systematic review of errors in inhaler use. Chest 2016;150(2):394-406