Challenges to the pharmacological management of chronic obstructive pulmonary disease (COPD) or asthma include correct inhaler device and medication, along with patient technique and acceptance of these devices for long-term management. While studies have indicated that inhaler devices can have similar efficacy with proper use, cognitive impairment, physical difficulties, motor skills, and other comorbidities (especially in older adults) can impact patient ability to use the device with proper techniques. A research report in the Annals of Pharmacotherapy is the first published study to compare the acceptability and inhaler technique for available asthma and/or COPD inhaler devices in a community setting.
A total of 161 patients with asthma and/or COPD who were using an inhaler device were recruited from eight study sites; patients were aged ≥6, receiving an inhaler device, and had a confirmed diagnosis of COPD and/or asthma. The inhaler devices tested were the Handihaler, pressurized metered dose inhaler (pMDI), pressurized metered dose inhaler with spacer (pMDI-S), Turbuhaler, and DISKUS.
Each patient demonstrated device technique and was rated based on five-point scale:
- 0 = No dose (none of the essential steps were followed)
- 1 = Poor dose
- 2 = Slightly less effective dose
- 3 = Mostly effective dose
- 4 = Completely effective dose was devised
Acceptability was overall high for all devices but effective use was generally worse, especially for the pMDI-S (mean 1.55 scale rating). Duration of asthma or COPD was not correlated with effective use of any device; in fact, the longer the time since the patient had received an asthma diagnosis, the less likely they were to correctly use the pMDI.
The authors encourage clinicians to initiate patient-centered communication on acceptability, preferences, and consideration of comorbidities in device selection that is individualized to each patient.
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