Inhalation Parameters in Patients with Asthma
Adherence to proper inhalation technique in patients with asthma may deteriorate within days of inhaler training, according to the results of a recent ad-hoc analysis.1
The researchers recorded information on usage and inhalation parameters such as peak inspiratory flow, inhalation volume, and inhalation duration to better understand adult patients’ inhaler technique at home. They found that use of the ProAir Digihaler, an integrated electronic multi-dose dry powder inhaler, may potentially indicate inhaler technique deterioration and/or inhaler use changes prior to an asthma exacerbation.
Lead author Nabeel Farooqui, MD, who is an adult and pediatric immunologist at Allergy Partners, PLLC, in Indiana, answered our questions about these findings, which he presented at CHEST2020.
Consultant360: Your team aimed to examine how inhaler technique changed or deteriorated following the completion of inhaler technique demonstration and training. Can you tell us more about the motivation behind your study?
Nabeel Farooqui: Inhalation therapies are the most effective treatment for respiratory diseases because the medication is delivered quickly to the site of action; however, such treatment is reliant on correct inhaler technique. Errors in inhaler technique are common and may limit the deposition of the medication, leading to ineffective therapy even if the patient adheres to treatment. Poor inhaler technique is associated with poorer clinical outcomes and an increased risk of exacerbations. Assessing objective information about inhaler technique may allow for opportunities to improve technique and thereby improve clinical outcomes.
C360: The results indicated that patient inhaler technique wanes within days of training. Did this outcome surprise you, or did you anticipate this?
Dr Farooqui: How quickly inhaler technique can deteriorate, even after appropriate training, may surprise many of our colleagues. The importance of these results lies in the relationship with patterns seen in inhaler use and specific inhalation parameters, such as peak inspiratory flow and inhalation volume. By assessing changes preceding an exacerbation, patterns can be observed that may help identify patients at risk of an impending exacerbation and allow for pre-emptive treatment. Although not used for this research study, the Digihaler system includes a companion smartphone app that provides feedback that may help patients self-manage inhaler use and share that data with their health care team.
C360: Your study notes that patients’ incorrect techniques resulted in a decrease of inhalation volume and duration. How can health care providers advise their patients for better adherence to proper inhalation technique?
Dr Farooqui: Our post-hoc analysis highlighted that a decrease in inhalation volume and duration can signal a decline in a patient’s inhaler technique. We would recommend that pulmonologists and allergists strongly consider frequent inhaler technique re-assessment and retraining as a part of patient encounter routine, especially if at-home inhaler use and technique are not remotely monitored by the patient and/or health care team.
C360: Can you talk about the importance of follow-up training? What roles do primary care providers have in the multidisciplinary approach to asthma care?
Dr Farooqui: Follow-up inhaler training, at both primary and respiratory specialty care levels, should become a more regular and routine component of in-person and remote health assessment. National and global asthma guidelines recommend that clinicians routinely assess their patients’ inhaler technique and recommend that inhaler technique and adherence is assessed prior to considering step-up therapy.
C360: What knowledge gaps still exist regarding patients’ inhaler technique?
Dr Farooqui: Insufficient objective information for real-world health care practice about patient inhaler use remains a major challenge in the management of patients with respiratory disease.
- Farooqui N, Safioti G, Granovsky L, et al. Inhalation parameters in patients with asthma using albuterol electronic multi-dose dry power inhaler. Paper presented at: CHEST 2020; October 18-21, 2020; Virtual. https://journal.chestnet.org/article/S0012-3692(20)32259-5/fulltext