title: Optimizing the inhalation flow and technique through metered dose inhalers of asthmatic adults and children attending a community pharmacy.
abstract: OBJECTIVE
  Despite training, many patients continue to misuse their metered dose inhaler (MDI). Research Ethics Committee approval was obtained to evaluate two different methods to help patients use a slow inhalation flow when they use their MDI.
  
  
  METHODS
  Asthmatic children (n = 17) and adults (n = 39) prescribed an MDI had their inhaler technique assessed. Those who achieved the recommended inhalation flow rate (IFR) of <90 l/min through their MDI formed the reference group (named (control--CT)). Others that had a poor inhaler technique with an IFR ≥ 90 l/min were randomized into either the verbal counseling (VC) group, who received verbal training on the correct MDI use with emphasis on using a slow IFR or into the 2ToneTrainer (2TT) group, who received the VC and a 2Tone Trainer to take home and use. 2TT is a training aid with audible feedback when the required slow inhalation flow is used. The participants were assessed on two occasions, 0 (baseline) and 6 weeks later.
  
  
  RESULTS
  For the asthmatic adults, the median IFR at visit 1 was 68, 200, and 240 l/min for the CT, VC, and 2TT groups, respectively. Whereas on visit 2, the median IFR was 88, 48.5 (p < .001), and 65 (p < .001) l/min for the CT, VC, and 2TT groups, respectively. Improvements in asthma quality of life were achieved in VC and 2TT groups. The asthmatic children showed a similar trend.
  
  
  CONCLUSIONS
  Training by VC and a training aid helps patients use a slow IFR with an MDI and improves asthma-related quality of life.
authors.affiliation: Institute of Pharmaceutical Innovation (IPI), Bradford School of Pharmacy, University of Bradford, Bradford, UK.
authors.forename: Wesam G
authors.initials: WG
authors.lastname: Ammari
authors.forename: Henry
authors.initials: H
authors.lastname: Chrystyn
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D003157:Community Pharmacy Services; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged