Table 2.

Strategies to ensure effective use of inhaler devices [2].

Choose

(i) Choose the most appropriate inhaler device for the patient before prescribing. Consider the medication options, the available devices,  patient skills, and cost

(ii) If different options are available, encourage the patient to participate in the choice

(iii) For pMDIs, use of a spacer improves delivery and (with ICS) reduces the potential for side effects

(iv) Ensure that there are no physical barriers, for example, arthritis, that limit the use of the inhaler

(v) Avoid use of multiple different inhaler types where possible, to avoid confusion

Check

(vi) Check inhaler technique at every opportunity

(vii) Ask the patient to show you how they use their inhaler (do not just ask if they know how to use it)

(viii) Identify any errors using a device-specific checklist

Correct

(ix) Show the patient how to use the device correctly with a physical demonstration, for example, using a placebo inhaler

(x) Check technique again, paying attention to problematic steps. You may need to repeat this process 2-3 times

(xi) Only consider an alternative device if the patient cannot use the inhaler correctly after several repeats of training

(xii) Recheck inhaler technique frequently. After initial training, errors often recur within 4–6 weeks

Confirm

(xiii) Clinicians should be able to demonstrate correct technique for each of the inhalers they prescribe

(xiv) Pharmacists and nurses can provide highly effective inhaler skills training

Reproduced with permission from [2]. pMDI, pressurized metered-dose inhaler; ICS, inhaled corticosteroids.