Errors are Common in Inhaler Use: A Systematic Review

Errors in Inhaler Use – both Metered-dose and Dry-powder 

Background: Correct use of inhalers is “key” for those with COPD to benefit from best available medications. Unfortunately, the medical profession has not done a good job in providing on-going education on proper use. Study: Dr. Sanchis and colleagues performed a systematic review of articles published over 40 years (1975 – 2014) which reported on direct observation of inhaler technique by trained nurses and respiratory therapists. The purpose was to identify common errors and the percentage of patients.  The article was published on-line on April 6, 2016, in the journal CHEST. Results: Information was available in 54,354 subjects. The most common errors with pressurized metered-dose inhalers were:
Example of pressurized metered-dose inhaler.

Example of pressurized metered-dose inhaler.

  1. no breath hold after full inhalation – 46%
  2. poor co-ordination between pushing down the canister and inhaling – 45%
  3. incorrect speed and/or depth of breathing in – 44%
The most common errors with dry-powder inhalers were:
Examples of dry-powder inhalers

Examples of dry-powder inhalers

  1. not breathing out completely before inhaling the powder – 46%
  2. no breath hold after full inhalation – 37%
  3. not preparing the inhaler correctly – 28%
Conclusions: Incorrect inhaler technique is common and has not improved over the past 40 years. There is an urgent need for new approaches in education. My Comments: Many of those with COPD need repeated review of correct inhaler use. Remember, the medication needs to reach the small breathing tubes deep in the lungs to make it easier to breathe. If you are not sure that you are inhaling correctly, ask your health care provider or nurse to watch you perform all of the steps.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.