Poor inhaler technique is among the commonest reasons asthma and COPD appear uncontrolled. Before stepping up treatment, ask the patient to demonstrate their inhaler with the device they use. For metered-dose inhalers, check slow, deep inhalation and use of a spacer; for dry-powder inhalers, check a fast, forceful breath. Correct one error at a time and recheck at the next visit. Also confirm the patient is taking the controller regularly and not relying on the reliever alone.
- Watch the patient use their own inhaler at every review.
- Recommend a spacer with metered-dose inhalers, especially in children and older adults.
- Match the device to the patient's ability to generate inspiratory flow.
- Confirm adherence before escalating to higher doses or biologics.
Why it matters
Many escalations treat a technique problem with a stronger drug.
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