The importance of inhaler technique in asthma and COPD management

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Defining inhaler technique in asthma and COPD

Inhaler technique in asthma and COPD is using an inhaler device correctly to ensure a patient receives the correct dose to effectively manage their symptoms.1, Inhalation therapy is the backbone of asthma and COPD control however, effective use of devices has continued to present challenges.2, When used correctly, inhalers are an efficient way to deliver medication directly to the lungs.3, When used incorrectly therapeutic effect is compromised, leading to poor control of asthma and COPD, increased risk of exacerbations, reduced lung function, and undesirable side effects.3,4,5,

Why does inhaler technique matter?

The correct use of inhaler technique is essential in asthma and COPD treatment, enabling the direct delivery of medication into the lungs to ensure the best effectiveness.6, It is important for people to recognise good inhaler technique as essential to maintaining their asthma and COPD control.

Why is poor inhaler technique so prevalent in asthma and COPD?

It’s been estimated that up to 92% of respiratory patients don’t use their inhaler correctly.7,

The prevalence of poor control in the UK raises the question, what are the primary factors contributing to this issue? Advanced Nurse Practitioner Rachel Voller has over 20 years of nursing experience and works as part of the Primary Care Network Respiratory team. She believes too much inhaler choice and a lack of patient education plays a key part:

‘‘With hundreds of different types of inhalers on the market it is no wonder that both health professionals and patients alike become confused by the different techniques required for each device.”

Blanket switching of inhalers without proper instruction increases the chance of error and complex regimes can lead to non-adherence.4,

Ensuring correct inhaler education for patients can lead to improved health outcomes and reduced inhaler consumption, contributing to a sustainable healthcare approach.8,

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Besides the most common errors, it is important to note that there is not the one ‘perfect device’. Several studies have shown that inhaler technique errors made by patients with asthma and COPD are common in real life with both pMDIs and DPIs. This highlights the critical importance of assessing inhaler technique to guide appropriate inhaler prescribing tailored to the individual.9,10,11, Rachel explains for patients using multiple devices, often a combination of pMDIs and DPIs, can become confusing and can lead to critical error in use.7, “We call these errors ‘critical’ because of the negative effects they can have. If a patient is receiving a suboptimal dose of their medication due to errors in their technique it can lead to a decline in their condition.”

Respiratory Nurse Consultant, Joanne King, explains the importance of ensuring patients are using the most suitable device.

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To aid understanding of why a patient may be struggling with their technique, it can be beneficial to see things from the patient’s perspective. Below, Asthma + Lung UK detail five of their most common inhaler errors:12,

Common errors in technique Example
Incorrect technique for a specific inhaler Incorrect technique for a specific inhaler
Not using a spacer Spacers are used with a pMDI to ensure the correct amount of medicine gets into the patients’ lungs
Incorrect breathing Breathing out fully before inhaling medicine gives it the best chance of reaching the small airways deep inside the patients’ lungs
Positioning Ensuring that the patient is sat or stood in an upright position along with holding the inhaler upright
Irregular inhaler use Regular use of an inhaler is the most effective way of managing a patients symptoms


‘‘By becoming aware of these errors as professionals, we can address our knowledge deficits through training and collaborative working as multidisciplinary teams’’ Rachel explains.

The role healthcare professionals play in inhaler technique

Patient education and being involved in decision making is essential to ensuring good inhaler technique. Of course, that begins at the initiation of therapy; if technique is poor from the outset there is a greater risk of reduction in the effectiveness of medication. Therefore, provision of clear instructions and device demonstration at initiation of therapy is essential.13,

Exploring ways in which healthcare professionals (HCPs) can support their patients, Rachel examines the crucial role they play: ‘‘Not all patients will be given a device demonstration or written instructions when new medication is commenced and will rely upon trial and error or advice from family and friends often leading to misinformation. HCPs have a responsibility to ensure that they are appropriately trained and qualified to deliver the care they are required to provide to avoid misinformation.’’

Opportunities for interactions with health professionals have increased with the widening of clinical roles in the NHS. The evolving role of pharmacists is helping bridge the gap in healthcare access and patient care; the primary role to be an expert in medicine has now shifted to that of a caregiver, committed to person-centred care by ensuring the high-quality use of medicines.14,15,

Rachel explains ‘’It is no longer solely the remit of a nurse or doctor to provide such instruction and well-trained individuals from within the wider multi-disciplinary team can play a valuable role in the delivery of this service.’’

Additional factors are to ensure the patient is prescribed a tailored device for their needs and how prescribing for asthma and COPD can differ when it comes to inhaler technique. Considerations around ensuring you find the right device for the right patient should be:16,

  • patient’s ability to use the device
  • patient’s lifestyle and circumstances
  • patient’s preference
  • age, competency, and physical ability.

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How can we help improve inhaler management and technique?

Improving inhaler management and technique is integral to managing a person’s respiratory condition and involves a combination of resources including patient engagement, empowerment, and educational materials.

Ensuring that people with asthma and COPD are supported to use their inhalers as prescribed is of the utmost importance, by doing so, patients can better manage their condition.

This extends beyond patient education, emphasising the vital role of nurses and other HCP roles in the process. Rachel states the most important considerations are:

  • 1. Appointments and Reviews

    This means effective respiratory management requires a partnership between the person with the condition (or caregiver) and their healthcare professional.17, So, what can be done by healthcare professionals to help, given time and resource pressures experienced by all? Rachel says “Prior to the patient’s appointment it is useful to read their history and understand what devices they currently use, have used in the past, note any previous changes, why they were made, and examine any co-morbidities.” This will allow for preparation and opportunity for the healthcare professional to research further if the device is unfamiliar to them. In reviews / appointments, patients should be asked to demonstrate how they use their inhalers. This will allow the observer to note any critical errors and provide instructions on how to resolve these.18,

  • 2. Changes to device

    Any change to the device should be made with caution as this can present further opportunity for errors.18, Device continuity if changing treatment is therefore recommended where possible, if the patient has demonstrated good technique with their existing device.


    Evidence indicates that HCPs play an important role in encouraging patients to participate in decisions about their treatment so adopting a shared-cared approach (where patient goals and preferences are accommodated), along with educational tools such as asthma and COPD action plans and video guides can improve patient outcomes.19,

  • 3. Resources

    Rachel concludes “Ultimately, it is our goal to work with our patients to ensure that we match the correct device and medication to them to aid in keeping them well, reducing disease progression and maintaining concordance with therapy and patient satisfaction.”


    You might find these resources for you and your patients helpful:


Key takeaways

The significance of teaching proper inhaler technique cannot be overstated. It is the forefront in ensuring for better respiratory management, effective medicine delivery and disease control. Empowering patients with this knowledge not only improves their quality of life but also alleviates the burden on the NHS. Prioristing comprehensive inhaler education is a key step towards reducing disease progression in both asthma and COPD.

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UK-RES-2102745 - May 2022

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