Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT).
Health professionals tasked with advising patients with asthma and chronic obstructive pulmonary disease (COPD) how to use inhaler devices properly and what to do about unwanted effects will be aware of a variety of commonly held precepts. The evidence for many of these is, however, lacking or old and therefore in need of re-examination. Few would disagree that facilitating and encouraging regular and proper use of inhaler devices for the treatment of asthma and COPD is critical for successful outcomes. It seems logical that the abandonment of unnecessary or ill-founded practices forms an integral part of this process: the use of inhalers is bewildering enough, particularly with regular introduction of new drugs, devices and ancillary equipment, without unnecessary and pointless adages. We review the evidence, or lack thereof, underlying ten items of inhaler 'lore' commonly passed on by health professionals to each other and thence to patients. The exercise is intended as a pragmatic, evidence-informed review by a group of clinicians with appropriate experience. It is not intended to be an exhaustive review of the literature; rather, we aim to stimulate debate, and to encourage researchers to challenge some of these ideas and to provide new, updated evidence on which to base relevant, meaningful advice in the future. The discussion on each item is followed by a formal, expert opinion by members of the ADMIT Working Group.
General Practitioner and Respiratory Lead, Harrow, London, UK.
Mark L
http://orcid.org/0000-0002-1807-3246
ML
Levy
Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
P N R
PN
Dekhuijzen
National Heart and Lung Institute, Imperial College London, London, UK.
P J
PJ
Barnes
University Medical Centre Nijmegen, Nijmegen, The Netherlands.
M
M
Broeders
Department of Respiratory Medicine and Allergy, King's College London School of Medicine, London, UK.
C J
CJ
Corrigan
COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
B L
BL
Chawes
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
L
L
Corbetta
Unité de Medicine Infantile, Marseille, France.
J C
JC
Dubus
Essen, Germany.
Th
T
Hausen
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
F
F
Lavorini
Service de Pneumologie et Soins Intensifs Respiratoires, Groupe Hospitalier Cochin, Université Paris-Descartes, Paris, France.
N
N
Roche
Departament de Pneumologia, Hospital de la Santa Creuide Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
J
J
Sanchis
NIHR Career Development Fellow, National Heart and Lung Institute (NHLI), Imperial College London, UK.|Royal Brompton Hospital, London, UK.
Omar S
OS
Usmani
Hospital General Yagüe de Burgos, Spain.
J
J
Viejo
Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Dienst Pneumologie, Brussels, Belgium.
W
W
Vincken
Krankenhaus Bethanien, Moers, Germany.
Th
T
Voshaar
Edinburgh, UK.
G K
GK
Crompton
Pediatric Research Unit, University of Southern Denmark, Kolding Hospital, Kolding, Denmark.
Soren
S
Pedersen
D000280:Administration, Inhalation; D000336:Aerosols; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004867:Equipment Design; D006801:Humans; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
D000336:Aerosols; D001993:Bronchodilator Agents