The following references and web links provide additional information on inhaler technique, inhaler misuse, and how changes in inspiratory flow affect the outcome of inhaled drug therapy.
Research and References
Sites that discuss inhaler technique
How to use your Metered Dose Inhaler - The Asthma Society of Canada
How to use your inhaler - Asthma UK
Inhalers for Asthma - Patient information Leaflet Prodigy (UK Department of Health, National Health Service, SCHIN)
Inhalers for COPD - Patient information Leaflet Prodigy (UK Department of Health, National Health Service, SCHIN)
How to use your metered dose inhaler Helen Davis, pharmacist (Tiscali Lifestyle - Health and Nutrition)
It’s All About Control (Good asthma management depends on prevention and optimal delivery of inhaled medications during attacks) John D. Zoidis, MD RT Magazine March 2005
COPD treatments Science Daily , December 2004.
Maximise the Mist - Allergy & Asthma Today article on keeping your inhaler clean and primed, ready for use. Winter 2005.
Inhaler technique in patients
Comparison of the effectiveness of inhaler devices in asthma and chronic
obstructive airways disease: a systematic review of the literature.
Brocklebank D, Ram F, Wright J, Barry P, Cates C, Davies L, Douglas G,
Muers M, Smith D, White J. Health Technol Assess. 2001;5(26):1-149
Demonstrated use of metered-dose inhalers and peak flow meters by children and adolescents with acute asthma exacerbations. Scarfone RJ, Capraro GA, Zorc JJ, Zhao H. Arch Pediatr Adolesc Med. 2002 Apr;156(4):378-83
Evaluation of conventional press-and-breathe metered-dose inhaler technique in 501 patients. Larsen JS, Hahn M, Ekholm B, Wick KA. J Asthma. 1994;31(3):193-9.
Misuse of metered-dose inhalers in hospitalized patients J Thompson, T Irvine, K Grathwohl and B Roth Chest 1994;105:715-717
Assessing metered-dose inhaler technique: comparison of observation vs.
patient self-report Erickson SR, Horton A, Kirking DM. J
Asthma. 1998;35(7):575-83
Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study) Garcia-Aymerich J, Barreiro E, Farrero E, Marrades R, Morera J, Anto J. Eur Respir J 2000; 16: 1037±1042
Assessment of Handling of Inhaler Devices in Real Life: An Observational
Study in 3811 Patients in Primary Care Molimard M, Raherison
C, Lignot S,Depont F, Abouelfath A, Moore N. Journal of Aerosol Medicine
Sep 2003, Vol. 16, No. 3: 249-254
Medicines education could save lives Poor knowledge of how drugs and inhalers work, coupled with complex prescribing regimes, are contributory factors in up to half of the 1,400 fatal cases of asthma in the UK each year. Asthma UK
Most Aerosol Asthma Therapies Created Equal - But patients must know how to use them, new guidelines state. Study shows all aerosolised medication delivery systems, or inhalers, are equally effective when used properly (quoting original review here)
Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines American College of Chest Physicians/American College of Asthma, Allergy, and Immunology Dolovich MB et al Chest. 2005;127:335-371
Inspiratory flow rates of school
children who use metered dose inhalers (abstract). Conlin T.P. Respir
Care 2002;47(9):1074.
Inspiratory flow rates of children who use metered dose inhalers. Conlin
T. Poster P-21, National Conference on Asthma 2003,Washington, D.C.
Metered Dose Inhaler Technique in health professionals
Do health professionals have sufficient knowledge and skill to teach optimum inspiratory flow (OIF) ? A study using the In-Check DIAL (ICD) to evaluate inspiratory technique. Pearce L Am J Respir Crit Care Med 2002;165(8):B3
Metered-dose inhaler technique among healthcare providers practising in Oman
Sawsan A. Baddar, Omar A. Al-Rawas, Kassim A. Al-Riyami, Elizabeth A. Worthing, Yolande I. Hanssens, Aqeela M. Taqi1, Bazdawi M.S. Al-Riyami SQU Journal For Scientific Research: Medical Sciences 2001, 1, 39-43
Pharmacists' understanding of patient education on metered-dose inhaler
technique SR Erickson, HM Landino, BJ Zarowitz, and DM Kirki
The Annals of Pharmacotherapy: Vol. 34, No. 11, pp. 1249-1256
Evaluation of pharmacists' practice in patient education when dispensing
a metered-dose inhaler. Mickle TR, Self TH, Farr GE, Bess DT, Tsiu
SJ, Caldwell FL. DICP. 1990 Oct;24(10):927-30.
Inspiratory flow rates by Respiratory Therapists using the In-Check DIAL
Conlin T. Respir Care 2004;49 (11):p1425
Inspiratory flow through inhalers affects outcome
A brief introduction to inhaled pharmaceutical aerosols (IPAs).
Aerosol Research Laboratory of Alberta
Aerosol deposition considerations in inhalation therapy Newman
SP. Chest. 1985 Aug;88(2 Suppl):152S-160S
Aerosol deposition in the human lung following administration from a
microprocessor controlled pressurised metered dose inhaler. Farr SJ,
Rowe AM, Rubsamen R, Taylor G. Thorax 1995;50:639-644
Effect of inhalation flow rate on the dosing characteristics of dry
powder inhaler (DPI) and metered dose inhaler (MDI) products. Ross
DL, Schultz RK. J Aerosol Med. 1996 Summer;9(2):215-26.
Effects of various inhalation modes on the deposition of radioactive
pressurized aerosols. Newman SP, Pavia D, Garland N, Clarke SW. Eur
J Respir Dis Suppl 1982;119:57-65
Optimizing Deposition of Aerosolized Drug in the Lung: A Review Holly J. Carveth, MD, Richard E. Kanner, Medscape 2000
How should a pressurized beta-adrenergic bronchodilator be inhaled? Newman SP, Pavia D, Clarke SW. Eur J Respir Dis 1981 Feb;62(1):3-21
2Tone Trainer improves asthma quality of life scores and maintains good inhaler technique
Maintenance of good inhalation technique for metered dose inhalers (MDIs) by using a two-tone trainer Al-Showair RAM, Pearson SB, Chrystyn H. Proceedings of the American Thoracic Society International Conference, San Diego USA, May 20-25, 2005
Reference books
Asthma - Rapid Reference Mark L Levy, Linda Pearce ISBN 0-7234-3360-7 www.elsevierhealth.com
British National Formulary (49th, March 2005) British Medical Association & The Royal Pharmaceutical Society of Great Britain
If any of the links become obsolete, then please email Canday Medical Ltd.
Last updated: 26/4/05
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