How often do you see people on tv use an asthma inhaler, only to exhale or start talking straight away? Instruction leaflets typically ask the user to hold their breath for at least 5 seconds before breathing out, yet I can count on the fingers of one hand, how many times I’ve seen this portrayed accurately.
If media portrayal is so inaccurate, it’s no surprise that most asthma patients don’t really know how to use their devices. Recent research found that only 7% of them use inhalers correctly, getting the full benefit of their prescribed medication.
It matters, because repeated under dosing results in poor management of the condition, often leading to people being put on stronger inhalers than they actually need. Dr Samantha Walker, director of research and policy at Asthma UK, said in a recent BBC interview, “This is also hugely wasteful – asthma-prescribing is one of the most expensive areas of cost for the NHS, costing almost £1bn annually.”
Much reliance is placed upon the patient reading, and keeping hold of, their instruction leaflet. But, we know that 60 percent of users won’t ever look at that leaflet, let alone refer to it later on. Training, particularly during an annual visit to the asthma clinic, is often relied upon to “fix” poor technique. How effective can a 5 minute session be for unlearning habits that have been reinforced over many months?
Guidance from FDA includes a hierarchy of ways to mitigate device risks. At the top sits design changes, designing out use errors or reducing their occurrence, training and then instruction leaflets sit at the bottom.
Poor inhaler technique can, at least in part, be mitigated through the design changes incorporated into breath actuated inhalers and capsule inhalers. So perhaps the changes being called for recently by UK healthcare charities should extend to use of appropriate alternative devices, to improve disease management and reduce long-term costs to the health service.
It’s not just asthma patients that struggle. Studies in the US show that just 16% of people prescribed adrenalin auto-injectors used them properly. People often didn’t hold the injector in place for at least 10 seconds or didn’t push down forcefully enough to allow the adrenalin in. Auvi-Q is a great example of a device that seeks to address these problems. It talks the user through each step, even counting up to 10 for them whilst they’re injecting.