title: Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD.
abstract: BACKGROUND
  Incorrect usage of inhaler devices might have a major influence on the clinical effectiveness of the delivered drug. This issue is poorly addressed in management guidelines.
  
  
  METHODS
  This article presents the results of a systematic literature review of studies evaluating incorrect use of established dry powder inhalers (DPIs) by patients with asthma or chronic obstructive pulmonary disease (COPD).
  
  
  RESULTS
  Overall, we found that between 4% and 94% of patients, depending on the type of inhaler and method of assessment, do not use their inhalers correctly. The most common errors made included failure to exhale before actuation, failure to breath-hold after inhalation, incorrect positioning of the inhaler, incorrect rotation sequence, and failure to execute a forceful and deep inhalation. Inefficient DPI technique may lead to insufficient drug delivery and hence to insufficient lung deposition. As many as 25% of patients have never received verbal inhaler technique instruction, and for those that do, the quality and duration of instruction is not adequate and not reinforced by follow-up checks.
  
  
  CONCLUSIONS
  This review demonstrates that incorrect DPI technique with established DPIs is common among patients with asthma and COPD, and suggests that poor inhalation technique has detrimental consequences for clinical efficacy. Regular assessment and reinforcement of correct inhalation technique are considered by health professionals and caregivers to be an essential component of successful asthma management. Improvement of asthma and COPD management could be achieved by new DPIs that are easy to use correctly and are forgiving of poor inhalation technique, thus ensuring more successful drug delivery.
authors: Unità Funzionale di Medicina Respiratoria, Università Degli Studi di Firenze, Italy.
authors: Federico
authors: F
authors: Lavorini
authors: Antoine
authors: A
authors: Magnan
authors: Jean Christophe
authors: JC
authors: Dubus
authors: Thomas
authors: T
authors: Voshaar
authors: Lorenzo
authors: L
authors: Corbetta
authors: Marielle
authors: M
authors: Broeders
authors: Richard
authors: R
authors: Dekhuijzen
authors: Joaquin
authors: J
authors: Sanchis
authors: Jose L
authors: JL
authors: Viejo
authors: Peter
authors: P
authors: Barnes
authors: Chris
authors: C
authors: Corrigan
authors: Mark
authors: M
authors: Levy
authors: Graham K
authors: GK
authors: Crompton
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D006801:Humans; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012646:Self Administration; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents