Improper use of an inhalation device may occur during any step of the process, including setup, administration, or cleaning.1,2
Incorrect breathing technique and lack of breath-holding are the most common examples of incorrect dry-powder inhaler (DPI) administration among patients with respiratory conditions, including COPD, according to a review of 50 studies that evaluated DPI usage.3
Though DPIs and metered-dose inhalers (MDIs) offer portability and short treatment times, patients may experience administration challenges with hand-breath coordination or lack of dosing feedback (eg, audio or visual), which can result in improper medication delivery. The inspiratory effort may also affect the inhalation of medicine.1,4
2Setup and cleaning challenges
While nebulizers offer passive administration (ie, tidal breathing), patients may use these devices improperly if they do not clean them daily or set them up properly.1,5,6
All devices are accompanied by detailed instructions for setup, administration, and cleaning. Multiple steps to set up the device, administer medicine, and care for the device can pose challenges for patients, which may impact adherence.1,2
References: 1. Tashkin DP. A review of nebulized drug delivery in COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:2585-2596. 2. Restrepo RD, Alvarez MT, Wittnebel LD, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-384. 3. Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593-604. 4. Koehorst-ter Huurne K, Movig K, van der Valk P, van der Palen J, Brusse-Keizer M. The influence of type of inhalation device on adherence of COPD patients to inhaled medication. Expert Opin Drug Deliv. 2016;13(4):469-475. 5. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest. 2005;127(1):335-371. 6. Dhand R, Dolovich M, Chipps B, Myers TR, Restrepo R, Farrar JR. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9(1):58-72.