Why focus on technique?
Handheld inhaler (HHI) technique errors may be more common than you think.1-5 Dexterity, inspiratory force and hand-breath coordination should be regularly assessed. Assessment for technique errors can help inform your decisions about appropriate treatment for your COPD patients.5*
Find out whether any of the following common “myth-conceptions” about HHI technique errors sound familiar.
*
The impact of patient conditions and device choice on clinical outcomes has not been demonstrated.
How common are errors in HHI technique?
myth
“The rate of handheld inhaler errors is very low.”
fact
Many patients using HHIs make at least 1 error.2 Many patients have issues that can impede their ability to use an HHI correctly.6,7*
When evaluating a COPD treatment option, it’s important to consider the patient’s ability to use the selected device correctly. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria recommend education and training (including the “teach-back” approach) at treatment initiation. Additionally, technique should be reassessed at each visit to ensure patients are using their device correctly.5
*
The impact of device choice on clinical outcomes has not been demonstrated.
When might nebulized maintenance therapy be an option for appropriate patients?
myth
“Nebulized maintenance therapy should only be reserved for patients with very severe COPD.”
fact
Nebulized maintenance therapy may be an appropriate option for many patients, regardless of their COPD severity.5,8
According to the GOLD criteria, maintenance therapy, regardless of delivery device, can be prescribed for many patients, regardless of their COPD severity.5
Can technique errors affect hospitalization risk?
myth
“Inhalation technique errors do not contribute to hospitalizations.”
fact
Critical errors in inhalation technique have been found to be associated with increased risk of hospitalization and emergency room visits.1 Therefore, if a patient isn’t responding to current therapy, it is important to reassess and check his or her inhalation technique before modifying therapy. The 2021 GOLD criteria recommend reassessment at every visit to determine whether patients are achieving treatment goals. This includes:
- Review of symptoms (eg, dyspnea) and exacerbations5
- Assessment of inhaler technique and adherence, and nonpharmacological approaches (including pulmonary rehabilitation and self-management education)5
- Adjustment of therapy (eg, escalate, switch inhaler device or molecules, de-escalate as necessary)5
References: 1. Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930-938. 2. Cho-Reyes S, Celli BR, Dembek C, et al. Inhalation technique errors with metered-dose inhalers among patients with obstructive lung diseases: a systemic review and meta-analysis of U.S. studies. Chronic Obstr Pulm Dis. 2019;6(3):267-280. 3. Souza ML, Meneghini AC, Ferraz E, et al. Knowledge of and technique for using inhalation devices among asthma patients and COPD patients [in English and Portuguese]. J Bras Pneumol. 2009;35(9):824-831. 4. Sanchis J, Gich I, Pedersen S; Aerosol Drug Management Improvement Team (ADMIT). Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150(2):394-406. 5. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2021 Report). https://goldcopd.org/2021-gold-reports/. Accessed December 3, 2020. 6. Hanania NA, Braman S, Adams SG, et al. The role of inhalation delivery devices in COPD: perspectives of patients and health care providers. Chronic Obstr Pulm Dis. 2018;5(2):111-123. 7. Sulaiman I, Cushen B, Greene G, et al. Objective assessment of adherence to inhalers by patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;195(10):1333-1343. 8. Gardenhire DS, Burnett D, Strickland S, et al. A Guide to Aerosol Delivery Devices for Respiratory Therapists. 4th ed. Irving, TX: American Association for Respiratory Care; 2017.
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