As a primary care pharmacist and educatorĀ I have spent nearly all my working life educating patients about inhaler use. I was horrified to see that despite the best efforts of the profession, inhaler technique has not improved. Are we ineffective? Or are the products just too difficult?
Article : Inhaler use: has technique improved over time?
A systematic review found that around 30% of people using inhalers had āpoorā inhaler technique, and that no appreciable change in this has occurred over the last 40Ā years. The review had several limitations making it difficult to draw firm conclusions from the findings. However, national guidelines on chronic obstructive pulmonary disease and asthma make several recommendations on inhaler technique, in particular the need to ensure that people receive training and can demonstrate satisfactory technique before an inhaler device is prescribed. Assessment of inhaler technique during routine reviews is also recommended.
Ref NICE Awareness on line 31/08/16
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The evidence suggests that patients need their device technique assessed regularly. After 6 months technique declines with many critical errors. So pharmacists have a key role in assessing and discussing inhaler technique at every dispensing and every time Ventolin is sold. Constant reinforcement is needed to maintain optimal technique and therefore outcomes.
Asking “have you had this before” really shuts down the conversation.
I have tried quite a few times to discuss this with my patients. Every conversation gets shut down very quickly no matter which way I format the question. I would be interested to hear how other pharmacists accomplish this important task. Often times I just end up referring them to the Asthma council website or give then a how to flyer. I find a lot of customers are too proud or too rushed to care.Di
HMRs…..very easy to engage the patient in their own home. 90% of people I see on inhaler therapy have inadequate inhaler technique. ~50% report never being shown how to use it. The number of patients who simply stop therapy due to confusion astounds me. ~25% are getting no value from inhaler therapy at all due to these problems.
I have seen…..a ventolin used directly on the chest, turbuhaler via a spacer, mouldy devices from incorrect storage, spiriva capsules swallowed, ventolin overuse at 1 inhaler/day…….and much much more
Hi Di
I think this is true for many community pharmacists. HMRs or medschecks conducted in a private counseling room are the best environment but obviously we can’t reach all patients with these services.
The PSA journal Australian Pharmacist has a good article by Bandana Saini on inhaler use.
She quotes 3 key steps :
1. Watch, don’t just ask
2. Show, don’t just tell
3. Repeat, don’t just dispense
The article also had some sample questions to help engage patients. I would suggest avoiding yes/no (closed) questions e.g “have you used the inhaler before?”
I usually ask permission e.g. “Is it ok to show you how to use this inhaler so you get the full effect?”