The influence of age, diagnosis, and gender on proper use of metered-dose inhalers.

Abstract

Metered dose inhalers (MOls) are widely used in clinical practice for administering pharmaceuticals targeted to the lung. It is well known that the inhalation technique used with MOls can substantially influence the clinical response to inhaled medications. Todetermine the acceptability of MOl maneuvers, we studied 59 subjects (26 females and 33 males; age, 20 to 81 yr; mean age, 38 yr) to determine whether the MOl technique used by these individuals complied with published recommendations for acceptable inhalation technique. Measurements were made with an MOl adapter that contained an unobtrusive, lightweight, miniature sensing system. Inspiratory flow at the moment of MOl actuation (Va), the volume (integrated from airflow) at actuation as a fraction of total inspiratory volume 0/aM), breath-holding time (tBH), and inspiratory volume as a fraction of FVC 0/I/FVC) were determined from 59 uncoached inhalations. We defined an acceptable maneuver, based on published data, by four components: (1) inspiratory flow at actuation (Va) between 25 and 90 Umin; (2) actuation during early inspiration (0 < VaM~0.20); (3) adequate breathholding time (tBH >4 s), and (4) a deep inhalation (VIIFVC >0.50). For all subjects, only 25% of inhalation maneuvers met all four criteria for acceptability. We found that a significantly higher proportion of male than female subjects performed an acceptable MOl maneuver (43% versus 4%, p < 0.001). There were no significant differences in technique between younger and older subjects or between patients with a diagnosis of asthma or chronic obstructive pulmonary disease (COPO). We conclude that most patients use their MOls incorrectly; females of all ages are much more likely to have improper MOl technique than are males. Goodman DE, Israel E, Rosenberg M, Johnston R, Weiss ST, Drazen JM. The influence of age, diagnosis, and gender on proper use of metered-dose inhalers. Am J Respir Crit Care Med 1994;150:1256-61.

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

“…Finally, as our questionnaire assessed actual treatment and not just prescription, adherence to treatment could influence the proportion of patients with maintenance treatment. Yet, adherence and correct inhaler technique have been reported to be equal between sexes [32] or even better in men [33,34] and subsequently should not explain our results. In summary, more research in sex differences and its implications for therapy is obviously needed [35,36].…”

Inhaler technique: does age matter? A systematic review

“…Studies differed according to methodology, with 10 employing an observational, cross-sectional methodology [4,5,7,[19][20][21][22][23][24][25], one an observational, comparative, cohort methodology spanning 18 months [26], one a comparative, cross-sectional methodology employing a community intervention [27], one a comparative, cohort study employing a community intervention spanning 4 weeks [28], and one employing a randomised-controlled-trial cohort design spanning 6-10 weeks (supplementary table S2) [29].…”

“…The included studies were published between 1979 [20] and 2015 [25], with samples ranging from 59 [7] to 3995 [4] participants, and ages ranging from 6.1 years [24] to older adulthood. Age thresholds for older adults varied between investigations.…”

“…Six studies were observational, with five applying a cross-sectional approach [4,7,[19][20][21] and one applying a cohort approach, reassessing participants over 18 months [26]. One employed a community training intervention prior to assessment, examining patients at that point in time [27], and one employed a cohort randomised controlled trial approach, randomising patients into two separate training interventions and assessing patients at baseline and 6-10 weeks afterwards [29].…”

“…From the currently available data, across all ages, as many as 90% of patients are estimated to demonstrate incorrect technique [4], contributing to increased hospitalisations [5] and forfeiture of billions of dollars in pharmaceutical expenditure [6]. An otherwise vulnerable population, the elderly, are particularly at risk, on account of increased evidence of cognitive and physical disorders affecting their ability to emulate and retain required skills [7,8].…”