Patient handling of a dry-powder inhaler in clinical practice

Background: Multi-dose dry-powder inhalers are perceived as being easier fo r patients to use than conventional pressurized aerosol inhalers; however, no study has determined whether patients handle such devices adequately and whether there is a need for patient education in this area. Method: We used trained observers to assess the handling of a specific mult i-dose dry powder inhaler (Turbuhaler; AstraZeneca Canada; Mississauga, ON) by patients currently using the device for the management of their asthma. Fourteen discrete steps were scored independently by two observers simulta neously. Patients were divided into two groups for analysis: those who had received formal instruction in the use of the inhaler at The Asthma Centre and those who had received no formal instruction in the community. Results: There was no significant difference between the formally trained g roups and control groups in the percentage of handling steps performed corr ectly (79% vs 78%, respectively; p>0.05). Fewer than 50% of patients in bot h groups demonstrated optimal breath-holding when using the device. Conclusion: Patient handling of Turbuhaler was generally good, with no evid ence that a structured education intervention offered an advantage over the usual education incidental to the prescribing or dispensing process. The m ost common handling flaw, suboptimal breath-holding, is not specific to thi s device and is of uncertain clinical significance.