University of Huddersfield Repository Improved Metered Dose Inhaler Technique When a Coordination Cap Is Used

BACKGROUND Patients often experience problems using metered dose inhalers (MDIs), particularly poor coordination between inhalation start and dose actuation (TsIn: time difference between the start of an inhalation and the actuation of a dose), and fast peak inspiratory flow (PIF). We investigated if a coordination cap (CAP), with instruction to prolong inhalation, solved these problems. METHODS Inhalation profiles [PIF, TsIn, inhalation volume (Vi), inhalation time (Ti)] of patients with stable asthma prescribed an MDI were measured using their real-life technique (MDI). Inhalation profiles were then measured with the cap fitted (MDI+CAP). These patients were then instructed to inhale through the MDI+CAP for 5 sec, and inhalation profiles measured (MDI+CAP+TRAIN). TsIn was only measured for the MDI. RESULTS Resistances of MDI and MDI+CAP were 0.0135 and 0.0243 (cm H2O)(½)/(L/min), respectively. Seventy-one patients were evaluated, with mean [standard deviation (SD)] forced expiratory volume over 1 sec % predicted normal of 78.3% (21.0). Following MDI, MDI+CAP, and MDI+CAP+TRAIN: mean (SD) PIF was 155.6 (61.5), 112.3 (48.4), and 73.8 (34.9) L/min, respectively (p<0.001); mean (SD) Ti was 1.60 (0.60), 1.92 (0.80), and 2.99 (1.03) sec, respectively (p<0.001); and Vi was similar between stages. Twelve patients used a slow flow with the MDI alone, but only two of these patients demonstrated good coordination. With the cap in place (which ensures good coordination), the number of patients using a slow flow increased to 25 for MDI+CAP and to 50 following MDI+CAP+TRAIN. CONCLUSIONS The cap with its effect of increasing resistance to airflow combined with the instruction to prolong inhalation time significantly decreased the inhalation flow.

[1]  Marco Lodi,et al.  Erratum to “Inhaler mishandling remains common in real life and is associated with reduced disease control” [Respir Med 105 (6) 2011 930–938] , 2012 .

[2]  J. Mitchell,et al.  Do we always need computed tomography to detect and treat parapneumonic pleural effusion? , 2012, European Respiratory Journal.

[3]  S. Hurd,et al.  The GINA Asthma Challenge: reducing asthma hospitalisations , 2011, European Respiratory Journal.

[4]  Marco Lodi,et al.  Inhaler mishandling remains common in real life and is associated with reduced disease control. , 2011, Respiratory medicine.

[5]  M. Levy,et al.  Technique training does not improve the ability of most patients to use pressurised metered-dose inhalers (pMDIs). , 2011, Primary care respiratory journal : journal of the General Practice Airways Group.

[6]  R. Pauwels,et al.  Lung deposition and efficacy of inhaled formoterol in patients with moderate to severe COPD. , 2007, Respiratory medicine.

[7]  H. Chrystyn,et al.  The potential of a 2Tone Trainer to help patients use their metered-dose inhalers. , 2007, Chest.

[8]  Linda Abetz,et al.  Identifying 'well-controlled' and 'not well-controlled' asthma using the Asthma Control Questionnaire. , 2006, Respiratory medicine.

[9]  Q. Hamid,et al.  New insights into the pathophysiology of the small airways in asthma. , 2006, Clinics in chest medicine.

[10]  P. Sestini,et al.  Inhalation technique and variables associated with misuse of conventional metered-dose inhalers and newer dry powder inhalers in experienced adults. , 2004, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[11]  Christiane,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2004, Journal international de bioethique = International journal of bioethics.

[12]  W. Hop,et al.  Inhalation profiles in asthmatics and COPD patients: reproducibility and effect of instruction. , 2003, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[13]  N Moore,et al.  Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care. , 2003, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[14]  D. Price,et al.  Improvement of asthma control with a breath-actuated pressurised metred dose inhaler (BAI): a prescribing claims study of 5556 patients using a traditional pressurised metred dose inhaler (MDI) or a breath-actuated device. , 2003, Respiratory medicine.

[15]  N Roche,et al.  Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability , 2002, European Respiratory Journal.

[16]  Wolzt,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2003, The Journal of the American College of Dentists.

[17]  B. Penninx,et al.  Determinants of an incorrect inhalation technique in patients with asthma or COPD. , 2001, Scandinavian journal of primary health care.

[18]  P. Barry,et al.  Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. , 2001, Health technology assessment.

[19]  G H Guyatt,et al.  Development and validation of a questionnaire to measure asthma control. , 1999, The European respiratory journal.

[20]  G. Crompton,et al.  Peak inspiratory flow through Turbuhaler in acute asthma. , 1995, The European respiratory journal.

[21]  S J Farr,et al.  Aerosol deposition in the human lung following administration from a microprocessor controlled pressurised metered dose inhaler. , 1995, Thorax.

[22]  E. Israel,et al.  The influence of age, diagnosis, and gender on proper use of metered-dose inhalers. , 1994, American journal of respiratory and critical care medicine.

[23]  H. Chrystyn,et al.  Investigations of an optimal inhaler technique with the use of urinary salbutamol excretion as a measure of relative bioavailability to the lung. , 1993, Thorax.

[24]  J E Cotes,et al.  Lung volumes and forced ventilatory flows , 1993, European Respiratory Journal.

[25]  J E Cotes,et al.  Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. , 1993, The European respiratory journal. Supplement.

[26]  A. Hollingworth,et al.  The relationship between powder inhaler resistance and peak inspiratory conditions in healthy volunteers--implications for in vitro testing. , 1993, Journal of aerosol medicine : the official journal of the International Society for Aerosols in Medicine.

[27]  S. Clarke,et al.  Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. , 1991, Thorax.

[28]  K. Nikander,et al.  Peak inspiratory flow and inspiratory vital capacity of patients with asthma measured with and without a new dry-powder inhaler device (Turbuhaler). , 1990, The European respiratory journal.

[29]  P. Barnes,et al.  Autoradiographic visualization of muscarinic receptor subtypes in human and guinea pig lung. , 1990, The American review of respiratory disease.

[30]  P. Barnes,et al.  Autoradiographic visualization of beta-adrenoceptor subtypes in human lung. , 1985, The American review of respiratory disease.

[31]  S. Newman,et al.  Aerosol deposition considerations in inhalation therapy. , 1985, Chest.

[32]  D. Pavia,et al.  Effects of various inhalation modes on the deposition of radioactive pressurized aerosols. , 1982, European journal of respiratory diseases. Supplement.

[33]  G K Crompton,et al.  Problems patients have using pressurized aerosol inhalers. , 1982, European journal of respiratory diseases. Supplement.

[34]  M. H. Williams,et al.  The adequacy of inhalation of aerosol from canister nebulizers. , 1980, The American journal of medicine.

[35]  H S Shannon,et al.  Effect of lung function and mode of inhalation on penetration of aerosol into the human lung. , 1977, Thorax.

[36]  G. Crompton,et al.  Use of pressurised aerosols by asthmatic patients. , 1976, British medical journal.

[37]  K. B. Saunders.  Misuse of Inhaled Bronchodilator Agents , 1965, British medical journal.