Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature

Abstract

et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess 2001;5(26). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see opposite). NHS R&D HTA Programme T he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme. This has meant that the HTA panels can now focus more explicitly on health technologies ('health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care) rather than settings of care. Therefore the panel structure has been redefined and replaced by three new panels: Pharmaceuticals; Therapeutic Procedures (including devices and operations); and Diagnostic Technologies and Screening. The HTA Programme will continue to commission both primary and secondary research. The HTA Commissioning Board, supported by the National Coordinating Centre for Health Technology Assessment (NCCHTA), will consider and advise the Programme Director on the best research projects to pursue in order to address the research priorities identified by the three HTA panels. The research reported in this monograph was funded as project number 97/23/02. The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

Assessment of inhalation technique and predictors of incorrect performance among patients of chronic obstructive pulmonary disease and asthma

“…This finding is in coherence with a systematic review of inhaler devices by Brocklebank et al which combined results from studies of more than one inhaler type, and found that maximum or "ideal" inhaler scores were attained by 59% of subjects with DPIs, 43% with MDI alone, and 55% with MDI plus holding chamber. 26 Most commonly performed error in the inhalation technique was in step number eight, ten and four by 100% of patients using pMDI and pMDI with spacer and 88% of the patients using DPI at baseline which decreased to 90%, 88% and 73% respectively at the same step after intervention.…”

Patient Education and Adherence to Aerosol Therapy

“…The reported prevalence of incorrect inhalation technique varies from 4 to 94%. 10,[24][25][26][27] There are many reasons behind incorrect inhalation technique. Patients may be confused with devices requiring different inhalation techniques or have difficulty using their aerosol devices correctly.…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…anti-leukotrienes, LTRAs) in moderate asthma conclude that ICS produce better outcomes, though whether this is true for all patients with mild or intermittent asthma is debated. [56][57] Such trials do not address the practical issues that impact on effectiveness in real-life primary care practice such as inadequate inhalation technique, 58 perceived side effects of steroids, 59 patient preference for regular treatment, and the impact of adherence. 60 …”