Optimizing the Inhalation Flow and Technique Through Metered Dose Inhalers of Asthmatic Adults and Children Attending a Community Pharmacy

Abstract

Objective. Despite training, many patients continue to misuse their metered dose inhaler (MDI). Research Ethics Committee approval was obtained to evaluate two different methods to help patients use a slow inhalation flow when they use their MDI. Methods. Asthmatic children (n = 17) and adults (n = 39) prescribed an MDI had their inhaler technique assessed. Those who achieved the recommended inhalation flow rate (IFR) of <90 l/min through their MDI formed the reference group (named (control—CT)). Others that had a poor inhaler technique with an IFR ≥ 90 l/min were randomized into either the verbal counseling (VC) group, who received verbal training on the correct MDI use with emphasis on using a slow IFR or into the 2ToneTrainer (2TT) group, who received the VC and a 2Tone Trainer to take home and use. 2TT is a training aid with audible feedback when the required slow inhalation flow is used. The participants were assessed on two occasions, 0 (baseline) and 6 weeks later. Results. For the asthmatic adults, the median IFR at visit 1 was 68, 200, and 240 l/min for the CT, VC, and 2TT groups, respectively. Whereas on visit 2, the median IFR was 88, 48.5 (p < .001), and 65 (p < .001) l/min for the CT, VC, and 2TT groups, respectively. Improvements in asthma quality of life were achieved in VC and 2TT groups. The asthmatic children showed a similar trend. Conclusions. Training by VC and a training aid helps patients use a slow IFR with an MDI and improves asthma-related quality of life.

• 2ToneTrainer
• asthma control
• inhalation flow rate
• inhalation technique
• quality of life
• verbal counseling

Acknowledgments

The authors thank all the patients who took part in this research study. This clinical research would not have been carried out without the support of the following community pharmacies who facilitated the access of the researcher, Dr. Ammari, to recruit the study patients and carry out all the study-related procedures: Cullingworth Pharmacy, TESCO Pharmacy (Halifax Road), Steeton Pharmacy and Denholme Pharmacy—Bradford, West Yorkshire (United Kingdom).

Declaration of interest

Wesam Ammari has no conflict of interest. Henry Chrystyn has no shares in any pharmaceutical companies. He has received sponsorship to carry out studies, together with some consultant agreements and honoraria for presentations, from several pharmaceutical companies that market inhaled products. These include AbdiIbrahim, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Innovata Biomed, Meda, Mundipharma, Omron, Sandoz, Teva, Truddell, and UCB. Research sponsorship has also been received from grant awarding bodies (EPSRC and MRC).