Recent research has shown that almost half of people with asthma are not using their inhaler properly1, meaning that not only could they be susceptible to side effects like oral thrush but more importantly they may not be getting the medicine they need to prevent a life-threatening asthma attack.
As healthcare professionals, we know inhalers can be problematic for asthma patients. There are many common mistakes that patients can make when using an inhaler including breathing in too forcefully or not forcefully enough, not breathing in deeply enough, or not preparing their inhaler properly before use, such as shaking the device.
But while there are two main types of inhaler, – dry powder inhalers (DPIs) and pressurised metered dose inhalers (MDIs) - within each group there are many different types of devices which may need to be taken in different ways. Research shows this is a challenge, with around 93% of healthcare professionals not knowing how to use asthma inhalers in some way.2
Poor inhaler technique can result in reduced or no inhaled medicine getting into a patient’s lungs where it is needed to reduce asthma symptoms such as coughing, wheezing or a tight chest. This means it is more likely the medicine stays in your patient’s mouth or throat, which can lead to side effects such as a sore throat or oral thrush.
Poor inhaler technique for reliever inhalers can also increase the amount of medicine absorbed into the bloodstream which could lead to side effects such as shakiness, headaches and an increased heart rate.3
So, we know how vital inhaler technique is but how can we be expected to know the different techniques needed for all the variations of inhaler? And how can we explain them to patients in a digestible way in the short appointment times we have with them?
We might only see our patients once a year at their annual asthma review so even if we teach them the correct technique, how can we be sure they are continuing to use it for the rest of the year when they are managing their asthma?
Finally, how do we overcome other barriers that prevent people with asthma from using their inhalers properly: lack of understanding about the importance of using inhalers, forgetfulness or embarrassment?
Well, Asthma UK has provided a solution - 21 easy-to-follow, instructional videos on its website that show you how to use many of the different types of inhalers, spacers and nasal sprays. They’ve been endorsed by the UK Inhaler Group, a not-for-profit coalition of organisations and individuals from highly respected bodies, making the information accurate and of the highest standard.
This up-to-date video library can be used by doctors and other healthcare professionals for free to explain technique to patients, and patients can be directed to the videos before, during, or after their annual asthma review. This means people with asthma can access them freely on their mobile phones, helping them to further improve their inhaler technique when they are outside of a clinical setting, whether at home or on the go.
Asthma UK hopes that by GPs using these videos and sharing them it will help patients better understand how to use their inhalers. Something as simple as writing a URL on the back of your patients’ prescription could help to prevent asthma attacks.
After all, the inhaler technique is a key part of basic asthma care that as healthcare professionals we are expected to deliver. The yearly asthma review with patients is the perfect opportunity for us to check our patient’s inhaler technique, using the videos as an engaging aid.
There are other barriers that need to be overcome. We hear anecdotally that many people with asthma are embarrassed about using their inhaler. The only way to deal with that is to keep reiterating the seriousness of asthma to your patient. Taking their inhaler regularly and correctly will help them manage their asthma. Not taking it could put them at risk of having a fatal asthma attack.
When it comes to encouraging patients to take their inhaler, I explain how important it is for their preventer inhaler to be used regularly to dampen down the inflammation in the airways and reduce the risk of asthma symptoms and asthma attacks. I also try to talk to them about getting into a good routine with their medication and advise them to keep their preventer inhaler somewhere that reminds them to take it. Sticking to a good routine helps patients take their inhaler as an everyday habit, like brushing their teeth.
It’s crucial that GPs and our teams feel confident in explaining inhaler techniques and that people with asthma know how to use their inhaler correctly. The hope is that the videos and tips will enable doctors and other healthcare professionals to deliver better basic care for patients, and help patients better manage their asthma to reduce their chance of having a potentially life-threatening asthma attack.
Dr Andy Whittamore is clinical lead at Asthma UK and a GP with a special interest in asthma. For more information and to access Asthma UK’s inhaler videos, visit www.asthma.org.uk/
- Exact figure is 45.6%. The study states that a critical error in exhalation technique can '…impact the effectiveness of the delivered drug and thereby lead to the suboptimal disease control of asthma and COPD'. Henry Chrystyn et al, Device errors in asthma and COPD: systemic literature review and meta-analysis, NPJ Prim Care Respir Med 2017; 27:22. Available at https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC5434773/[accessed 20 February 2019].
- Baverstock et al, Do healthcare professionals have sufficient knowledge of inhaler techniques in order to educate their patients effectively in their use, (November 2010), published in Thorax, https://thorax.bmj.com/
content/65/Suppl_4/A117.3[accessed 20 February 2019].
- The National Institute for Health and Care Excellence, https://bnf.nice.org.uk/drug/
salbutamol.html#sideEffects[accessed 20 February 2019]. Common side effects of salbutamol include arrhythmias, dizziness, headache, hypokalaemia, nausea, palpitations, tremor.