Aspects important for selection of the appropriate device for an individual patient
When selecting an aerosol delivery device the following questions should be considered:
In which device is the desired drug available?
Which device will the patient be able to use correctly, given the patient’s age and clinical setting?
For which device and drug combination is reimbursement available?
Can all types of inhaled drugs prescribed for the patient be delivered by the same type of device?
Which device is most convenient for the patient regarding time of drug administration, device cleaning or portability?
How long can the device be used?
From controlled clinical trials no significant differences appear to exist between different kind of devices concerning their efficacy and tolerability. Therefore it can be assumed that an ideal patient thoroughly instructed in the correct use of his device can be treated successfully with any inhaler. However it has been demonstrated that only very few asthmatics meet the selection criteria of controlled trials. Therefore decision on a particular device cannot be made on the basis of a few predefined patient characteristics but should take into account theindividual situation and preference of a certain patient.
Dolovich MB, Ahrens RC, Hess RD, Anderson P, Dhand R, Rau JL, Smaldone GC, Guyatt G. Device selection and outcomes of aerosol therapy: evidence-based guidelines. 2005. Chest; 127 (1): 335-371
Herland K, Akselen JP, Skjonsberg OH, Bjermer L. How representative are clinical study patients with asthma or COPD for a larger “real life”? population of patients with obstructive lung disease? 2005. Respiratory Medicine; 99: 11-19
DECISION TREE FOR THE SELECTION OF A PARTICULAR KIND OF DEVICE
NEED FOR INSTRUCTION OF PATIENTS AND PROFESSIONALS
In numerous studies it has become obvious that the correct use of an inhalation device is critical for effective treatment. Therefore patients have to be instructed thoroughly how to use their device. Prerequisite for successful instruction is that the prescribing authorities themselves are well-informed and familiar with issues concerning performance and correct use.
As early as 30 years ago, several studies already demonstrated deficiencies in patients andhealth care professionals concerning the use of inhalation devices. Despite educational efforts incorrect use of inhaler devices is still frequently observed. In a study including more than 700 patients, 466 nurses and 428 physicians only 9% of patients showed a correct inhalation technique with metered dose inhalers (MDI). Although physicians performed significantly better than nurses (28% vs. 15%) this study showed severe deficiencies regarding the instruction knowledge of professionals.
However high quality instruction on the correct use of inhaler devices leads to significantimprovement concerning the inhalation technique. In general group instructions appear to generate better results than personal education. Considerable improvement can also be achieved by video instructions. Since coordination using a MDI is more difficult for the patient normally higher improvement rates are observed regarding inhalation technique of MDIs compared with DPIs.
van der Palen J, Klein JJ, Kerkhoff AH, van Herwaarden CL, Seydel ER. Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines. 1997. Patient Educ Couns; 32 (Suppl. 1): S87-95
Plaza V, Sanchis J. CESEA group. Medical personnel and patient skill in the use of metered dose inhalers: a multicentric study. 1998. Respiration; 65: 195-198
IMPROVEMENT OF INHALATION TECHNIQUE IN RELATION TO INSTRUCTION METHOD