Making asthma inhaler checks more effective- on and offline

Incorrect inhaler technique is entwined with nonadherence and doubts about asthma inhaler treatment.⁴ It is not hard to understand why this might be: why take the time to learn a complicated series of steps to use an inhaler correctly and then follow these regularly if you don’t think it will improve your health? And, if you use an inhaler incorrectly or miss doses, you might feel less benefit from treatment, reinforcing doubts about the treatment and potential nonadherence. This can set off a vicious cycle.

A 2017 Cochrane review highlighted that interventions to improve asthma inhaler technique can help patients develop their technique but did not find strong effects on clinical outcomes.⁵ So how could inhaler checks be used to ensure people’s symptoms and quality of life improve, especially when delivered online? Here are some ideas using behavioural science.

First, get the basics right through demonstration and visual cues:

• Evidence suggests that the more actively patients engage with learning about their asthma medication, the more they will get out of it. Asking patients to demonstrate how they take their medication is more effective than showing them. Can patients film themselves on their mobile phone, or demonstrate online if not seen face-to-face?⁶
• Providing visual information such as videos and pictures is often more effective than verbal instruction, especially for patients who have low health literacy.⁷
• Repetition is also good. Providing support on multiple occasions and facilitating practice is likely to support patients to use their inhaler correctly from the start and to keep using it correctly over time.⁸

Next, consider the vicious cycle and address motivation.

• Even if someone is reviewed over the phone, the importance of inhaler technique can still be addressed through patient discussion, supplemented with extra online resources. For example, explaining what might happen if inhaler technique is poor. Or, if someone using a dry powder inhaler breathes in too slowly, their medication may not reach their lungs meaning they are still at risk of asthma exacerbations.
• Are there ways of demonstrating asthma inhaler technique that can help to normalise using an asthma inhaler and overcome feelings such as embarrassment about using inhalers in practice? For example, showing people taking asthma inhalers in public places rather than in private as part of the resource pack, or providing reassurance to patients as they demonstrate.

So, when thinking about demonstrating correct inhaler technique it might be important to look beyond initial behaviour, even when providing support outside of clinic.

¹ Annual asthma survey | Asthma UK

² GINA Main Report 2022 Front Cover (ginasthma.org)

³ Understanding Patient Perspectives on Medication Adherence in Asthma: A Targeted Review of Qualitative Studies - PMC (nih.gov)

⁴ Inhaler competence in asthma: Common errors, barriers to use and recommended solutions - ScienceDirect

⁵Interventions to improve inhaler technique for people with asthma - Fortescue, R - 2017 | Cochrane Library

⁶Effective behavior change techniques in asthma self-care interventions: Systematic review and meta-regression. - PsycNET (apa.org)

⁷Using pictures to convey health information: A systematic review and meta-analysis of the effects on patient and consumer health behaviors and outcomes - ScienceDirect

⁸Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence - ScienceDirect