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Majority of asthma actuations considered poor

The majority of actuations in patients with asthma were poor, regardless of whether or not the patient used either a rescue or a controller metered dose inhaler, according to findings presented at the American College of Allergy, Asthma and Immunology Annual Scientific Meeting.

“Based on guidelines and patient information leaflets, more than 30 seconds are needed between two inhalations to achieve proper [metered dose inhaler] use that includes shaking the canister, exhaling completely before inhalation, inhaling slowly and breath-holding after use,” William Anderson, MD, assistant professor of pediatric allergies and co-director of the Multidisciplinary Asthma Clinic at the University of Colorado School of Medicine, and colleagues wrote.

Researchers collected data from 7,558 patients older than 4 years with asthma who were using controller and/or rescue metered dose inhalers with an electronic medication monitor that passively collected time and date used. The period of time between the first two actuations was labeled as either acceptable (more than 30 seconds), fair (15 to 30 or less seconds), or poor (less than 15 seconds) in patient-days with two actuations within 120 seconds.

Anderson and colleagues found 6,616 of the patients used the rescue inhaler on 120,882 days and 3,220 patients used the controller inhaler on 157,492 days. The median interquartile range interval between actuations was 9 seconds. In addition, 16% of the actuations were acceptable, 17% were fair and 67% were poor. Results were nearly identical between rescue and controller metered dose inhalers.

“This study demonstrates that most patients have inadequate intervals between metered dose inhaler actuations. Electronic medication monitors were useful in detecting inadequate inhalation technique by examining the interval between actuations as a determinant,” Anderson and colleagues wrote. “This information can be used to inform patients and providers that inhalation technique education is needed to improve treatment.” – by Janel Miller

Reference:

Anderson W, et al. Frequency of improper inhaler technique identified by electronic medication monitor (EMM) actuation timing. Presented at: American College of Allergy, Asthma and Immunology Annual Scientific Meeting; Nov. 15-19, 2018; Seattle.

Disclosures: Please see the meeting’s abstract book for the authors’ relevant financial disclosures.