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      Matching Inhaler Devices with Patients: The Role of the Primary Care Physician

      review-article
      1 , , 2 , 3
      Canadian Respiratory Journal
      Hindawi

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          Abstract

          Poor inhaler technique and nonadherence impair the efficacy of medications for asthma and chronic obstructive pulmonary disease (COPD). A range of factors, including age, dexterity, inspiratory capacity, cognitive ability, health literacy, and ethnicity, can impact a patient's ability and intention to use their device. Treatment success can also be influenced by patient preferences and perceptions. Therefore, it is important that healthcare professionals effectively match inhaler devices to individual patients' needs and abilities and empower patients by including them in treatment decisions. Physicians must, therefore, fully understand the characteristics of each device, as well as their patients' demographic characteristics and comorbidities. Following device selection, patient training and education, including a physical demonstration of the device, are key to eliminate any critical errors that may impact on health outcomes. Inhaler technique should be frequently rechecked. This review will examine the important role of primary care providers in the selection of appropriate inhaler devices and provision of training for patients with COPD and asthma to optimize correct inhaler use and adherence. An overview of the key features of available devices and of the factors to consider when selecting devices will be provided in the context of current asthma and COPD guidelines.

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          Most cited references43

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          Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD.

          Incorrect usage of inhaler devices might have a major influence on the clinical effectiveness of the delivered drug. This issue is poorly addressed in management guidelines. This article presents the results of a systematic literature review of studies evaluating incorrect use of established dry powder inhalers (DPIs) by patients with asthma or chronic obstructive pulmonary disease (COPD). Overall, we found that between 4% and 94% of patients, depending on the type of inhaler and method of assessment, do not use their inhalers correctly. The most common errors made included failure to exhale before actuation, failure to breath-hold after inhalation, incorrect positioning of the inhaler, incorrect rotation sequence, and failure to execute a forceful and deep inhalation. Inefficient DPI technique may lead to insufficient drug delivery and hence to insufficient lung deposition. As many as 25% of patients have never received verbal inhaler technique instruction, and for those that do, the quality and duration of instruction is not adequate and not reinforced by follow-up checks. This review demonstrates that incorrect DPI technique with established DPIs is common among patients with asthma and COPD, and suggests that poor inhalation technique has detrimental consequences for clinical efficacy. Regular assessment and reinforcement of correct inhalation technique are considered by health professionals and caregivers to be an essential component of successful asthma management. Improvement of asthma and COPD management could be achieved by new DPIs that are easy to use correctly and are forgiving of poor inhalation technique, thus ensuring more successful drug delivery.
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            Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma

            American Journal of Respiratory and Critical Care Medicine, 181(6), 566-577
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              Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes.

              Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes.
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                Author and article information

                Contributors
                Journal
                Can Respir J
                Can. Respir. J
                CRJ
                Canadian Respiratory Journal
                Hindawi
                1198-2241
                1916-7245
                2018
                23 May 2018
                : 2018
                : 9473051
                Affiliations
                1Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada
                2University of Aberdeen, Aberdeen, UK
                3Observational & Pragmatic Research Institute, Singapore
                Author notes

                Academic Editor: Inmaculada Alfageme

                Author information
                http://orcid.org/0000-0001-8795-5528
                http://orcid.org/0000-0002-9728-9992
                Article
                10.1155/2018/9473051
                5989279
                10605365-7bad-4970-afc4-4f069b628dc2
                Copyright © 2018 Alan Kaplan and David Price.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 February 2018
                : 17 April 2018
                Funding
                Funded by: Boehringer Ingelheim
                Categories
                Review Article

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