Inhaler use is a critical aspect of respiratory care, yet many patients are unaware of the potential consequences of using them incorrectly. Liam Clutterbuck, a market access and engagement lead at Trudell Medical International, highlights a significant issue: incorrect inhaler technique can lead to medication not reaching the lungs effectively. This is a widespread problem, with up to 80% of people using pressurized metered dose inhalers (pMDIs) not using them correctly. This means that up to four million people in the UK alone may be using their inhalers incorrectly, which can have serious implications for their health.
The issue lies in the coordination required between actuation and inhalation. A recent study found that a mere 0.5-second inhalation delay reduced lung delivery to around 1% of the intended dose. This is a major concern, as it can lead to poor disease control and an increased risk of exacerbations. In the UK, around four people die from asthma each day, and two-thirds of these tragic outcomes could be prevented with enhanced basic care and improved treatment adherence.
One solution to this problem is the use of spacers, or valved holding chambers (VHCs). Spacers are a critical component of pMDI treatment, as they temporarily hold the medication within the chamber after it is released, making it easier for patients to inhale smoothly and breathe tidally. This significantly reduces throat deposition, where medication sticks to the back of the throat rather than reaching the lungs. Despite decades of evidence supporting their use, one in ten respiratory health professionals told us that spacers are still not prescribed consistently across the NHS. Many patients either do not receive one at all, are not properly instructed in how to use it, or choose not to use one.
There are many complex reasons for this gap, including a lack of standardized prescribing, variations in training, pressures in primary care, and a lingering misconception that inhalers are intuitive devices requiring minimal instruction. In reality, they demand careful teaching and regular review. Many patients simply aren't aware that when they take a puff of their pMDI, they may not be receiving the intended dose of medicine.
Improving inhaler technique is not a glamorous intervention, but it may be one of the most cost-effective and impactful steps we can take to improve respiratory outcomes. By improving patients' technique, our aim is to support improved disease control, reduce exacerbations, and ultimately, prevent avoidable loss of life. However, there is also a wider public education challenge to normalize spacer use. All too often, patients, especially adults, feel uncomfortable using spacer devices around other people. This dilemma needs to be addressed to improve cultural and social perceptions.
Without a spacer, a large proportion of the drug dose only reaches the throat or mouth, which may lead to localized conditions like oral thrush. An anatomical model study of one spacer evidenced that it can reduce medication deposition in the throat by up to 90% compared to pMDI alone. Therefore, improving inhaler technique and normalizing spacer use are crucial steps in improving respiratory outcomes and preventing avoidable loss of life.
