Case study: Allergists discuss common inhaler failure signs—and how to support patients in getting it right
MDlinx Oct 07, 2024
At CHEST 2024 the case-based session, “Avoid Inhaler Failure: When Is the Right Time to Switch?” drew a large, curious crowd. The speakers (including Sandra Adams, MD, FCCP, Megan Conroy, MEd, MD, FCCP, and De De Gardner, DrPh, RRT, FCCP of the Allergy and Asthma Network) set up two patient-simulated scenarios via a series of short videos, and encouraged participants to watch and discuss.
While many patients use medications such as steroids or biologics to help control their asthma, this session focused primarily on inhalers.
A look inside the session
Attendees were asked to sit together to handle prop inhalers and inspiratory flow devices of different sorts. Physicians were also instructed to use an inhaler that they weren’t familiar with, giving others who were a chance to share their experiences and instruct.
The discussion then centered around correct usage of inspiratory flow devices, using two common inhalers (RespiCLICK, a dry-powder rescue inhaler, and RESPIMAT, a soft mist inhaler). Clinicians assessed the simulated patient’s use of the inhalers. Did they use them correctly? Did they not? The room was abuzz with feedback. For patients experiencing inhaler failure, clinicians will want to look out for common mistakes.
RespiCLICK common use mistakes:
Clinicians said they noticed the patient shaking the inhaler and not breathing out fully. Patients shouldn’t hold the inhaler upside down, shake it, or blow into the device, Gardner adds.
RESPIMAT common use mistakes:
Clinicians noticed that the patient didn’t load the cartridge with medicine, and that they skipped priming the device. Other mistakes included taking a fast or shallow breath followed by immediately blowing out versus holding the breath.
Take home lesson to deliver to patients
An observational study published in the International Journal of Clinical Pharmacy found that “three out of four patients were making critical mistakes in the use of inhalers.”
Voices from the floor
As Kim Gilchrist, MD, from Media, PA told MDLinx, “It’s always important to reassess patient experience. We don’t often ask them to bring their devices into the office, but it’s helpful to demonstrate [in-person] how they use them,” she says. A key issue physicians will want to solve for? “It's challenging to fit [the instruction] into the visit. The staff have to be well trained, too, because the clinician is busy.”
Dr. Gilchrist’s suggestion is clear: “If everyone has a goal to optimize the experience, more and more patients would realize the benefits [of using an inhaler],” she says. It’s normal for patients to struggle with their inhalers. “We all fall short at times and no one is perfect. It’s about empowering your patient. If they’re struggling, they should know that it’s safe and okay to say, ‘this inhaler is not working for me’ or ‘I’m not liking this inhaler,” Dr. Gilchrist adds.
In her experience patients do need to switch inhalers from time to time—sometimes because it’s not working, and sometimes because it irritates them (for example, the dry powders negatively affect some patients).
“If they’re not doing well or experiencing more flare-ups,” Gilchrist says, it might be time to consider an inhaler change.
Voices from the floor
Dr. Adams describes a patient case to MDLinx, saying she worked with a patient with COPD who wasn’t using her inhaler or oxygen correctly—and that she ended up very depressed. Dr. Adams said that no one had ever really checked the patient’s technique for using the devices, though.
For Dr. Adams, it was about teaching her correct usage and boosting the patient’s confidence. As she told her patient, “This is not a death sentence. It’s a disease that can be managed. She can take control of her situation and really live a full life even though she had severe COPD. If she could quit smoking, she can learn the devices and embrace her oxygen,” she says.
At the office, Dr. Conroy said that clinicians may not even have an inhaler on hand with which to demonstrate. Moreover, some patients may forget which inhaler they have back home. In that case, she recommends thinking out of the box. “Use a teach back technique. Start with curiosity,” Conroy said.
An technique to implement
Clinicians in the session added their input on how to handle that situation. Some ideas that came up? Mimic the use with your hands, provide them with video links, show photos of the inhaler your patient thinks they use to confirm usage, or use graphics from the Asthma and Allergy Network to help patients learn.
The most helpful thing of all? “Longer business days,” one clinician jokes. The room agreed.
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