Poor inhaler technique and non-adherence are among the commonest reasons asthma and COPD appear uncontrolled. Errors such as not exhaling before inhaling, poor coordination with a pressurised inhaler, or too weak a breath through a dry-powder device can greatly reduce the dose reaching the lungs.
Established practice is to watch the patient use their own device, correct errors, and confirm adherence before adding or escalating treatment. A spacer improves delivery from pressurised inhalers in many patients.
- Ask the patient to demonstrate their inhaler at every review.
- Correct technique errors before increasing the dose or adding a drug.
- Consider a spacer for patients who struggle with a pressurised metered-dose inhaler.
- Keep to one type of device where possible to avoid confusion between techniques.
Why it matters
Escalating a drug the patient cannot inhale adds cost and side effects without benefit.
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