Choosing the inhaler |
Develop a standard procedure or follow a check-list: 1) choose drug in partnership with patient; 2) from the available inhaler types for that drug, match inhaler to patient, taking into consideration patient device preferences; 3) train and check inhaler technique; and 4) recheck technique at each visit and if symptoms occur |
Revisit the choice of drug and inhaler with the patient if symptoms persist |
Need for: devices |
Devices that are forgiving of poor technique (e.g. breath-actuated devices) |
“Intelligent” devices that provide positive feedback to the patient that dose emission has occurred and, ideally, that inhalation is correct |
Devices that provide a means of measuring adherence |
Need for: instruments/techniques |
Instruments/techniques to match patient inspiratory pattern to inhaler device type (e.g. based on breathing patterns and lung function) |
Inhalation hardware and software to chart inhalation pattern |
Need for: improving knowledge on inhalation patterns and flow rates necessary for acceptable and optimal use of inhalers |
Need for: tools to trace patients' adherence to treatment |
Training the patient |
Teach and ascertain correct technique from the start: 1) use the patient's “language”; 2) repeat and repeat; and 3) know their knowledge level |
Explain, demonstrate then physically check technique |
Train the patient’s relatives too |
Provide inhaler training for hospitalised patients before discharge |
Provide asthma school: group sessions for patients who find them useful (not all do) |
Need for: software or mechanical devices for training inhaler technique |
Need to: “train the trainer”; all HCPs (physicians, nurses, physiotherapists, pharmacists, and receptionists) should be able to provide patient training |
Need for: training and equipment so HCPs can use two steps to check inhaler technique: 1) visual evaluation (inexpensive); and 2) electronic evaluation with a device 4 to check for and identify mistake(s) in inhaler technique (expensive) |
Maintaining technique |
Supply a source of recommended reference material so the patient knows where to go if they have questions: both videos and written material |
Demonstrate and teach inhaler technique with each revisit |
Instruct patient to bring inhaler to each follow-up visit |
Mandatory recheck of technique if asthma not controlled |
Need for: use of electronic instructions and reminders |
SMS from doctor to patient: film/video on proper technique and reminder when to use inhaler |
Pocket computer or desktop reminders |
Need for: tools for patients to check their technique and use in self-management |