Poor inhaler technique is one of the commonest reasons asthma appears uncontrolled. Many patients exhale into the device, fail to coordinate actuation with inhalation, or do not hold their breath, and a dry-powder inhaler needs a fast, deep inspiration that some patients cannot generate.
Ask the patient to show you, using their own device, at every review where control is poor. Correct one error at a time and recheck. Consider a spacer with a pressurised inhaler, especially in children and older adults.
- Ask patients to demonstrate their inhaler at each review where asthma is not controlled.
- Correct technique and recheck before adding or increasing treatment.
- Use a spacer with pressurised inhalers in children and in adults who struggle with coordination.
- Match the device to the patient's inspiratory effort and dexterity.
Why it matters
Many apparent treatment failures are delivery failures that a two-minute check would find.
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