MEDA: Helpful and supportive tool for asthma therapy - DOs and DON'Ts of using inhalation devices
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One in four asthma patients sought emergency treatment for symptomatic asthma
during the last year and as many as 16% of asthma patients still use a rescue
inhaler on a daily basis[1]. One of the reasons for the lack of treatment
success may be due to patients not being able to use their inhalation devices
correctly[2],[3] since this applies to 50 percent of all asthma patients in
Europe[4],[5],[6]. A summary of the critical items important for correct
inhalation with the most frequently prescribed inhalation devices, recently
published on the website of the Aerosol Drug Management Improvement Team[4],
show that these items differ in terms of quantity among the various systems. The
Dry Powder Inhaler Novolizer® can be counted among those devices with the fewest
critical items that have to be considered. This implicates that the Novolizer®
is the easiest inhaler to use. It meets all the requirements of an ideal inhaler
since it combines ease and convenience of device use with reliable and
consistent dose release.
DOs and DON´Ts: Precise instructions for the correct use of inhalation devices
Several novel and unique educational tools for patients and healthcare
professionals, located on the ADMIT-website, provide basic information and
detailed instructions on the correct use of the most frequently prescribed
inhalation devices. They are likely to help to reduce handling errors and
maximize treatment outcomes with the selected inhaler. The "dos and don'ts per
inhaler" instructions comprise a collage with images (pictures) of the inhaler
devices
(http://www.admit-online.info/en/admit-advice/guidelines-and-recommendations/inh
alers-dos-and-donts). A click on "Mouse over" opens a list of instructions on
the correct use of the most common inhaler devices currently available on the
market. These instructions focus on the steps patients must take (DOs) and those
they must not take (DON'Ts) when using an inhalation device. It addresses key
issues, indicating those most likely to be forgotten or performed incorrectly by
patients.
Novolizer: easiest inhaler to use, only two items to be considered during use
When using a device critical items which differ among the various systems have
to be considered and avoided. These critical items may have detrimental effects
on clinical efficacy, since a poor inhalation technique minimizes drug delivery
to the lungs and patient compliance. When using the Novolizer® for example only
two critical items have to be considered which are due for all inhalation
systems, such as patients should not blow into the device and should not stop
breathing in when they hear the click. In contrast, patients using the
Aerolizer® for example, have to make sure that they do not swallow the capsule
or remove a capsule from the foil pouch until they actually need to take one,
not to let the inhaler or capsule get wet, not to shake or tilt the inhaler
after it has been loaded, not to blow into the inhaler, not to press the green
button more than once (capsule might break), not to store the inhaler or
capsules in a wet or damp environment, and finally not to leave the capsules in
the inhaler.
Considering the recommendations for DOs and DON´Ts it becomes evident that the
Novolizer® is the only inhalation device which meets all the criteria of an
easy-to-use and patient-friendly inhaler (whereas other inhalers fail almost
50% of the criteria) such as breath activation, FPF airflow rate, patient
feedback of dose taken, dose counter for doses actually taken, advance warning
of last dose, overdose / underdose secure, and reloadability. The Novolizer's®
unique multiple feedback signals (optical, acoustic and taste) confirm each
successful inhalation and provide confidence that the taken drug has reached the
lungs[11]. The Novolizer's unique dosage and correct inhalation counter
indicates not only "doses left" but also "correct inhalations taken",
"compliance" and "ready to inhale". The counter moves only after correct
inhalation and prevents over- and under-dose. The trigger threshold mechanism
corrects for poor patient inhalation technique. Even a flow rate of 35-50 L/min
produces a good lung deposition when using the Novolizer®[11]. This makes the
device suitable even for patients with impaired inspiratory capacity flow
rates[8],[9] such as children, elderly patients, or patients suffering from
severe airway obstruction.
Novolizer(®) improves patient compliance and asthma control
A post-marketing evaluation of the efficacy and acceptance of the Budesonide
Novolizer(®) revealed that the Novolizer(®) improved patient compliance by 80
%[7]. 97 % of patients were satisfied with the Novolizer's(®) correct inhalation
feedback signals and 91 % of patients preferred the Novolizer(®) to their
previous inhaler. The same evaluation showed that the Novolizer(®) improved lung
function (median FEV(1) +20%) and significantly improved asthma symptoms such as
coughing, wheezing, diurnal dyspnea, nocturnal dyspnea, and dyspnea during
physical exertion. It decreased the symptom score in asthma patients from 8 to
2. This outcome may be a result of the ease-of-use but could also be due to the
unique multiple-feedback mechanism reassuring the patient that the inhalation
was performed correctly and the medication to the lungs delivered
effectively[10].
General differences in the handling of DPIs and pMDIs
The second educational tool offers "general recommendations on the correct use
of pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs)"
from "taking the cap of" to "always keep a spare device/capsule"
(http://www.admit-online.info/en/admit-advice/guidelines-and-recommendations/rec
ommendations-pmdisdpis). These recommendations stress the most important
differences in the use of a DPIs or pMDI. Patients must shake the pMDI and hold
it upright during use, but should not shake a DPI. When using a pMDI, patients
are required to take slow, deep breaths. Shortly after starting the process of
breathing, patients must actuate the pMDI whilst maintaining a continuous
breathing pattern until their lungs are full. This breathing process should take
at least 5 seconds and should be slow and deep rather than short and sharp. In
contrast, when using a DPI, patients should breathe in as briskly, quickly and
deeply as possible.
The third list "different handling of inhalers" summarizes the key differences
in technique between pMDIs and
DPIshttp://www.admit-online.info/en/admit-advice/guidelines-and-recommendations/
handling-of-inhalers. The comparison showed that breath-actuated DPIs are easier
to handle and require less patient coordination than pMDIs which are more
difficult to handle since they require good coordination between actuation and
breathing. A correct inhalation technique in asthmatic patients is thus more
associated with DPIs than pMDIs. A systematic review and a meta-analysis[10]
confirmed these findings.
[1] Salynn Boyles, WEB MD Health News, Feb 2010, US-American survey
http://www.webmd.com/asthma/news/20100218/survey-asthma-control-still-poor
[2] Virchow JC, Ärztezeitung, 2007, 178; Österreichische 2007; 21
[3] Global Initiative for Asthma:www.ginasthma.com
[4] ADMIT: Aerosol Drug Management Improvement Team:www.admit-online.info
[5] Crompton GK et al, Resp Med 2006; 100:1479-1494
[6] Lavorini F et al. on behalf of ADMIT, Breathe December 2008, Volume 5, No
2, 120-131
[7] Möller M et al. Arzneum-Forsch/drg Res 2003:53(8): 562-567
[8] Newman SP et al. Respir Med 2002; 96: 293-304.
[9] Magnussen H. Curr Med Res Opin 2005 ; 21 : S39-S46
[10] Lavorini F et al. ERS Poster 2008
[11] Petzold et al., JOURNAL OF AEROSOL MEDICINE AND PULMONARY DRUG DELIVERY;
Vol.21, Number 3, 2008
www.novolizer.com
www.meda.se
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DOs and DON?Ts of using inhalation devices:
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Datum: 20.09.2010 - 10:00 Uhr
Sprache: Deutsch
News-ID 42833
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