Inhaler use is a critical aspect of respiratory care, yet many patients are unaware of the proper technique, which can lead to medication failure and poor disease control. Liam Clutterbuck, a market access and engagement lead at Trudell Medical International, highlights the issue of incorrect inhaler use, particularly with pressurized metered dose inhalers (pMDIs). Up to 80% of people don't use pMDIs correctly, which can result in a significant reduction in lung delivery, as evidenced by a study showing that a 0.5-second inhalation delay reduced lung delivery to around 1% of the intended dose. This is a widespread problem, as it is estimated that up to four million people in the UK could be using pMDIs incorrectly. The consequences of this error are serious, as it can lead to a lack of control over respiratory conditions, with asthma being a leading cause of preventable deaths in the UK. The issue is further compounded by the fact that many patients, especially young children, the frail elderly, or those with muscle weakness, may struggle to generate the required inspiratory force for dry powder inhalers (DPIs), making pMDIs a more appropriate choice. However, the use of pMDIs also requires careful coordination between actuation and inhalation, which can be challenging for patients. Spacers, or valved holding chambers (VHCs), offer a practical solution to mitigate these technique and coordination errors. They temporarily hold the medication within the chamber after it is released, making it easier for patients to inhale smoothly and breathe tidally, while significantly reducing throat deposition. Despite the evidence supporting their use, spacers are still not prescribed consistently across the NHS, with one in ten respiratory health professionals reporting that they are not consistently prescribed. This is due to a variety of factors, including a lack of standardized prescribing, variations in training, pressures in primary care, and a lingering misconception that inhalers are intuitive devices requiring minimal instruction. Many patients are also unaware that they may not be receiving the intended dose of medicine when they take a puff of their pMDI. To improve perception and normalize spacer use, public education is necessary. Patients, especially adults, often feel uncomfortable using spacer devices around other people, which can be addressed by working on cultural and social perceptions. Without spacers, a large proportion of the drug dose only reaches the throat or mouth, which can lead to localised conditions like oral thrush. An anatomical model study of one spacer evidenced that it can reduce medication deposition in the throat by up to 90% compared to pMDI alone. Improving inhaler technique is not a glamorous intervention, but it may be one of the most cost-effective and impactful steps we can take to improve respiratory outcomes. By supporting improved disease control, reducing exacerbations, and ultimately preventing avoidable loss of life, we can make a significant difference in the lives of those affected by respiratory conditions.
