Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT).

Health professionals tasked with advising patients with asthma and chronic obstructive pulmonary disease (COPD) how to use inhaler devices properly and what to do about unwanted effects will be aware of a variety of commonly held precepts. The evidence for many of these is, however, lacking or old and therefore in need of re-examination. Few would disagree that facilitating and encouraging regular and proper use of inhaler devices for the treatment of asthma and COPD is critical for successful outcomes. It seems logical that the abandonment of unnecessary or ill-founded practices forms an integral part of this process: the use of inhalers is bewildering enough, particularly with regular introduction of new drugs, devices and ancillary equipment, without unnecessary and pointless adages. We review the evidence, or lack thereof, underlying ten items of inhaler 'lore' commonly passed on by health professionals to each other and thence to patients. The exercise is intended as a pragmatic, evidence-informed review by a group of clinicians with appropriate experience. It is not intended to be an exhaustive review of the literature; rather, we aim to stimulate debate, and to encourage researchers to challenge some of these ideas and to provide new, updated evidence on which to base relevant, meaningful advice in the future. The discussion on each item is followed by a formal, expert opinion by members of the ADMIT Working Group.

Erratum: Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT).

[This corrects the article DOI: 10.1038/npjpcrm.2016.17.].

[One year of asthma treatment: a retrospective analysis of 57 patients in the year 1997]. / Ein Jahr Asthmatherapie--eine retrospektive Analyse an 57 Patienten aus dem Jahr 1997.

UNLABELLED: A persisting stabilisation without symptoms or exacerbations is the aim of modern asthma treatment. The costs on this basis are lower than we expected. METHODS: We collected data from all asthma patients who were treated for asthma in our practice in all 4 quarters of 1997 regarding treatment and prescriptions. RESULTS: Data from 57 asthma patients (34 women, 23 men), 39 with low degree asthma, 16 with medium degree and 2 with severe asthma, were analysed. The duration of treatment ranged from 5 to 13 years. The frequency of contacts with the practice and lung function tests changed according to the degree of severity with an average of 9.3 respectively 2.1. Emergency or hospital treatment did not become necessary. Apart from one female patient all others received inhalative glucocorticoids. The use of beta 2 agonists varied. The main costs of treatment and prescription was 524.30 euros, rising with the degree of severity. CONCLUSIONS: A successful and affordable treatment of asthma is possible. Combined with clinical examinations, peak-flow measurements and lung function tests the prescriptions can help in the staging of severity of asthma. Emergency treatment can thus be avoided.

[Acceptance of peak-flow measurement in out-patients]. / Die Akzeptanz der Peak-Flow-Messung in der Praxis.

UNLABELLED: There are a lot of indications for PEF-measurement of which the long-time observation of asthmatics is the most important one. Unfortunately not all patients are measuring regularly. The acceptance of PEF-measurement in patients who have got a PEF-monitor should be found out by a questioning in the following trial. METHOD: 65 patients who have got a prescription for a PEF-monitor since 1995 were asked to answer a questionnaire anonymously. RESULTS: 49 patients (24 female, 24 male, 1 without information) answered the questionnaire. 19 patients are still measuring, 30 patients stopped measuring because of lacking complaints. Patients measured regularly (n = 14). 4 irregularly, most frequently daily (n = 9), more rarely only weekly, monthly or casually, Measuring was done mostly in the morning (n = 8), 3 times a day (n = 5), 2 times at same time (n = 9). 11 patients measured before inhalation of a beta-agonist, 8 patients before and after inhalation as well. 7 patients recorded the values. Causes for measuring mostly were control and complaints. CONCLUSION: PEF-Measuring obviously will be accepted if the patient understands the necessity, f.e. for a short period of time at a moment of complaints or start or change of therapy. Under those circumstances most of our patients will be ready to do PEF-measurement regularly and daily and two to three times a day and at the same time and eventually with recording the values.