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Liam Clutterbuck, market access and engagement lead at Trudell Medical International, says that incorrect inhaler use means patients are unaware that medication may be failing to reach their lungs.
Inhalers have long been a cornerstone of respiratory care, offering fast, effective relief and controlling symptoms for people living with asthma and chronic obstructive pulmonary disease (COPD).
Pressurised metered dose inhalers (pMDIs) account for the vast majority of inhaler use, yet millions of patients may not be receiving the full benefit due to incorrect use.
While dry powder inhalers (DPIs) are an alternative to pMDIs, certain patient groups – such as young children, the frail elderly, or those with muscle weakness – may struggle to generate the required inspiratory force, making a pMDI a more appropriate choice.
When it comes to pMDI use, up to 80% of people don’t get the technique right, which suggests up to four million people in the UK could be using these inhalers incorrectly. A key difficulty is the coordination required between actuation and inhalation, these errors have a major impact on treatment. In fact, in a recent study, just a 0.5-second inhalation delay reduced lung delivery to around 1% of the intended dose.
Widespread challenge
This is not a marginal issue; it is a widespread challenge in basic respiratory care and can be seriously detrimental to patients’ control over their condition. In the UK alone, around four people die from asthma each day with reports suggesting two-thirds of these tragic outcomes could be prevented with enhanced basic care and improved treatment adherence.
Spacers – or valved holding chambers (VHCs) – offer a practical solution to mitigate these technique and coordination errors for pMDI users. Often overlooked or underutilised, spacers are a critical component of pMDI treatment. They temporarily hold the medication within the chamber after it is released, making it easier for patients to inhale smoothly and breathe tidally, while significantly reducing throat deposition – where medication sticks to the back of the throat rather than reaching the lungs.
Despite decades of evidence supporting their use, one in ten respiratory health professionals told us that spacers are still not prescribed consistently across the NHS. Many patients either do not receive one at all, are not properly instructed in how to use it, or choose not to use one.
There are many complex reasons for this gap, including a lack of standardised prescribing, variations in training, pressures in primary care and a lingering misconception that inhalers are intuitive devices requiring minimal instruction. In reality, they demand careful teaching and regular review. Many patients simply aren’t aware that when they take a puff of their pMDI, they may not be receiving the intended dose of medicine.
Improving perception
There’s also a wider public education challenge to normalise spacer use. All too often, patients, especially adults, feel uncomfortable using spacer devices around other people. We understand this dilemma, and work needs to be done to improve these cultural and social perceptions.
Without a spacer, a large proportion of the drug dose only reaches the throat or mouth, which may lead to localised conditions like oral thrush. An anatomical model study of one spacer evidenced that it can reduce medication deposition in the throat by up to 90% compared to pMDI alone.
Improving inhaler technique is not a glamorous intervention. But it may be one of the most cost-effective and impactful steps we can take to improve respiratory outcomes. By improving patients’ technique, our aim is to support improved disease control, reduce exacerbations, and ultimately, prevent avoidable loss of life.
