New initiative educates patients about inhaler use

The tutorial includes tips on the correct use of metered dose inhalers (MDIs), both with and without an assist device, and on the correct use of dry powder inhalers (DPIs). It also gives tips on the correct use of nebulizers. The tutorial explains the difference between rescue drugs and maintenance drugs, and tells patients when they should call their doctor.

In addition to the tutorial, the Web site features a glossary and a description of the medications and classes of drugs used to treat different pulmonary diseases, and it offers some general information about these medications. The site also has an area describing different tests to assess lung function and health, including spirometry.

Said Renee Ahrens Thomas, Pharm.D., MBA, an associate professor of pharmacy practice at the Bernard J. Dunn School of Pharmacy at Shenandoah University in Winchester, Va., "Pharmacists should counsel every patient that comes into the pharmacy with a new inhaler prescription about how to use the device properly, how many doses are contained in the inhaler, and how to tell if the inhaler is empty." Pharmacists must continually reinforce proper inhaler use, Ahrens Thomas said.

Leslie Hendeles, Pharm.D., a professor of pharmacy and pediatrics at the University of Florida in Gainesville, agreed. "Study findings indicate that it is particularly true of MDIs that patients do not use them properly. This is in part because neither the physician nor the pharmacist has taken responsibility for patient education. And this is especially true among those who are treated by primary care physicians."

He went on to say that "patients need frequent reeducation and observation, and pharmacists can play a significant role. When patients come into our clinic for follow-up, we have them or their parents-depending on the patients' ages-demonstrate inhaler use. We do this no matter how many times we have seen them in the past." He mentioned that "for many patients, we will prescribe a rescue medication that is breath-activated, or an inhaled steroid that comes in a DPI. These two devices are much simpler to use than a conventional MDI and require less training. Patients seem to be able to use them and get more medication into their lungs."

Pharmacists should also counsel patients about the difference between rescue and maintenance medications, said Ahrens Thomas. She pointed out that one of the biggest mistakes patients make is using their maintenance medication during an acute attack. Patients also may not appreciate the importance of maintenance medications, because they do not see an immediate effect from using them, Ahrens Thomas cautioned. She urged pharmacists to reinforce the importance of maintenance medications and compliance with the therapeutic regimen.

"Pharmacists can identify patients who overuse their rescue medications and bring this to the attention of the prescribing physician," Hendeles said. He cautioned that overuse of rescue medications puts patients at risk for hospitalization or death.

"Pharmacists can also identify those who underuse their maintenance medications, because they are not refilling their prescriptions often enough," said Hendeles. He encouraged pharmacists to collaborate with physicians in rectifying this situation.

Sam Giordano, executive director of AARC, said in a statement that there is a "great need for patient education about the proper use of inhalers. If a respiratory patient is using the device incorrectly, the needed medication is not getting to their lungs."

Ahrens Thomas noted that some pharmacies offer an in-depth asthma education program where they will work closely with those who have pulmonary disease. As part of the program, they help patients determine different parameters, such as their peak flow, and provide them with instruction on proper inhaler use.

THE AUTHOR is a clinical writer based in New Jersey.