title: "Trying, But Failing" - The Role of Inhaler Technique and Mode of Delivery in Respiratory Medication Adherence.
abstract: Inhaled therapies are the backbone of asthma and chronic obstructive pulmonary disease management, helping to target therapy at the airways. Adherence to prescribed treatment is necessary to ensure achievement of the clinician's desired therapeutic effect. In the case of inhaled therapies, this requires patients' acceptance of their need for inhaled therapy together with successful mastery of the inhaler technique specific to their device(s). This article reviews a number of challenges and barriers that inhaled mode of delivery can pose to optimum adherence-to therapy initiation and, thereafter, to successful implementation and persistence. The potential effects on adherence of different categories of devices, their use in multiplicity, and the mixing of device categories are discussed. Common inhaler errors identified by the international Implementing Helping Asthma in Real People (iHARP) study are summarized, and adherence intervention opportunities for health care professionals are offered. Better knowledge of common errors can help practicing clinicians identify their occurrence among patients and prompt remedial actions, such as tailored education, inhaler technique retraining, and/or shared decision making with patients regarding suitable alternatives. Optimizing existing therapy delivery, or switching to a suitable alternative, can help avoid unnecessary escalation of treatment and health care resources.
authors: Respiratory and Allergy Diseases Clinic, Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy. Electronic address: fulvio.braido@unige.it.
authors: Fulvio
authors: F
authors: Braido
authors: Research in Real Life, Cambridge, United Kingdom.
authors: Henry
authors: H
authors: Chrystyn
authors: Respiratory and Allergy Diseases Clinic, Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors: Ilaria
authors: I
authors: Baiardini
authors: Woolcock Institute of Medical Research, University of Sydney, NSW, Australia; Sydney Local Health District, Sydney, NSW, Australia.
authors: Sinthia
authors: S
authors: Bosnic-Anticevich
authors: Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Thys
authors: T
authors: van der Molen
authors: Montreal Chest Institute & Meakins-Christie Laboratories, McGill University Health Centre, Montreal, QC, Canada.
authors: Ronald J
authors: RJ
authors: Dandurand
authors: The Respiratory Effectiveness Group, Oakington, Cambridge, United Kingdom.
authors: Alison
authors: A
authors: Chisholm
authors: Optimum Patient Care, Unit 5-6, Oakington, Cambridge, United Kingdom.
authors: Victoria
authors: V
authors: Carter
authors: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.
authors: David
authors: D
authors: Price
mesh_terms: D000280:Administration, Inhalation; D006282:Health Personnel; D006801:Humans; D055118:Medication Adherence; D009330:Nebulizers and Vaporizers; D024382:Professional Role; D019141:Respiratory System Agents / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D019141:Respiratory System Agents
keywords: Adherence; Implementation; Inhaler device; Inhaler technique; Initiation; Patient preference; Persistence