a man asthma inhaler imageFebruary 27 2018

Asthma inhaler design could mean people with rheumatoid arthritis are unable to use the device or obtain optimal benefit, a new study has indicated.

Researchers from the University of Bath looked at the use of four commonly prescribed inhaler devices: the standard pressurised metered dose inhaler (pMDI), as well as the Easi-Breathe, HandiHaler and Turbohaler devices. The study involved 34 patients with rheumatoid arthritis and assessed inhaler use compared to the control group by using placebo inhaler devices. An In-Check Dial device measured the maximum inhalation flow rate.

Results indicated that “only 15% of the arthritis patients could complete all the steps to use one type of inhaler, called a HandiHaler, whereas 94% of the control group were able to. The HandiHaler requires seven steps to operate it properly, including removing a capsule of powered medicine from a foil blister pack, inserting it into the inhaler and piercing it for inhalation,” said the University.

“In contrast 85% of the arthritis patients and 100% of the control group could correctly use an inhaler called a Turbohaler, which has three steps; unscrewing a cap, twisting a dial and replacing the cap. Two other commonly prescribed inhalers saw the arthritis group struggle to complete the operating steps compared to the control group (50% to 91%, and 77% to 97%).”

The researchers have called on health professionals to help people with rheumatoid arthritis to find the most appropriate inhaler device for their needs.

Dr Matthew Jones, from the University’s Department of Pharmacy & Pharmacology, said: “These results show how important it is that health professionals make sure people can use any inhaler they prescribe. If someone gets home from a pharmacy with a new inhaler and finds they can’t use it, their lung disease will not be properly treated and the NHS loses money, as some inhalers cost more than £50 each.

“This simple training makes a real difference to how these patients can manage their respiratory disease. The consequences of not being able to physically operate an inhaler can be severe for patients, as badly treated asthma can be fatal.

“Pharmacists, doctors and nurses need to make these easy checks not only help patients achieve better outcomes but also reduce demand on the NHS, not to mention taking away the stress and irritation of a complex and difficult process for the patient. It’s a no-brainer.”

University of Bath announcement         
YS Shirmanesh and MD Jones. ‘Physical ability of people with rheumatoid arthritis and age-sex matched controls to use four commonly prescribed inhaler devices’. Respiratory Medicine. February 2018. 135: 12 – 14