Poor inhaler technique is one of the commonest reasons asthma and COPD appear uncontrolled. Before increasing doses or adding a drug, ask the patient to show how they use their device, and correct errors.
Spacers help with pressurised inhalers, and some patients do better switching to a device that suits their inspiratory flow and coordination. Adherence and triggers are the other two checks before escalating.
- Watch the patient use their inhaler at every review where control is poor.
- Offer a spacer with metered-dose inhalers, especially for older adults and children.
- Check adherence with refill records or direct questions before escalating.
- Consider a device change if technique cannot be corrected.
Why it matters
Many apparent treatment failures are device failures.
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