Teaching technique can improve patients’ ability to use their inhalers correctly. In the study cited by BTS/SIGN, correct usage score improved after teaching from a mean of 60% to 79%. Figures for no mistakes after teaching were 63% for pMDI, 65% for DPI, and 75% for breath-actuated MDI (the latter figure based on one study of 2,467 patients).1
Unfortunately many HCPs are unable to correctly demonstrate how to use the inhalers they prescribe.2 They may be unfamiliar with the use of specific devices, have inadequate time to teach, have poor training techniques and/or materials, or not provide follow up.3
With the increasing range of devices coming onto the market and the extensive range of treatment options available for each device, plus regular updates of national and international guidelines, it is important that HCPs periodically update their knowledge of both new inhalers and management standards.3,4
Checking and correcting inhaler technique using a standardised checklist takes only 2-3 minutes and leads to improved asthma control in adults and older children.2 GINA states that a physical demonstration is essential to improve inhaler technique. This is easier if the HCP has placebo inhalers (and a spacer if this has been prescribed). After training, inhaler technique ‘falls off’ with time, so checking and re-training must be repeated regularly. HCPs can provide highly effective inhaler skills training.2
The UK Inhaler Group Inhaler Standards and Competency document provides a framework to set, assess and support the standards of those initiating inhaler therapies, and checking and teaching inhaler techniques to optimise drug administration.5
It states that all HCPs prescribing an inhaler should ensure that the patient knows how to use the device, and if initiating the device, they should also know how to use it and be competent in teaching its use. Prescribers should be able to demonstrate device techniques correctly and clearly. Assessing and teaching technique may involve watching the patient use their inhaler, instruction, reinforcement and repeating these steps. Device technique should be checked on the prescribed device or the relevant, single use, placebo device.5
While assessment criteria for each individual inhaler device may vary, there are basic steps that apply to all inhalers.5
The seven steps to using an inhaler device are:5
If these areas are covered, then specifics for each inhaler can be assessed, and technique optimised.
The HCP should also identify any concerns that may affect the patient’s ability to use their inhaler, such as:5
When a patient is first prescribed an inhaler, it can be difficult to ensure that they are confident in its use due to pressures of time within the initial consultation and possibly because patients themselves are stressed and anxious.3 Nonetheless, it is crucial that training is provided.1,2
Instruction should also be provided to parents/carers,3,5 particularly in the case of children, and adults with learning difficulties or dementia.
Job code: UK/RES-19014d DOP: April 2020