Inappropriate inhaler use: assessment of use and patient preference of seven inhalation devices

Inefficient inhaler technique is a common problem resulting in poor drug de livery, decreased disease control and increased inhaler use. The aim of thi s study was to assess patients' use of different inhaler devices and to asc ertain whether patient preference is indicative of ease of use and whether current inhaler use has any influence on either technique or preference. We also wished to define the most appropriate method of selecting an inhaler for a patient, taking into account observed technique and device cost. One hundred patients received instruction, in randomized order, in the use of s even different inhaler devices. After instruction they were graded (using p redetermined criteria) in their inhaler technique. After assessment patient s were asked which three inhalers they most preferred and which, if any, th ey currently used. Technique was best using the breath-actuated inhalers; t he Easi-Breathe(R) and Autohaler(R), with 91% seen to have good technique. The pressurized metered dose inhaler (pMDI) Fared poorly, in last position with only 79% of patients showing good technique, despite being the most co mmonly prescribed. The Easi-Breathe(R) was by far the most popular device w ith the patients. The Autohaler(R) came in second position closely followed by the Clickhaler(R) and Accuhaler(R). The majority of patients (55%) curr ently used the pMDI but the pMDI did not score highly for preference or ach ieve better grades than the other devices. Only 79% of patients tested coul d use the pMDI effectively even after expert instruction yet it continues t o be commonly prescribed. This has important repercussions for drug deliver y and hence disease control. Prescribing a patient's preferred device incre ases cost but can improve efficiency and therefore be cost effective in the long term. Using an inexpensive device (pMDI) when technique is good and t he patient's preferred inhaler device when not is one way to optimize deliv ery and may even reduce cost.