Slow and Steady wins the race - Can the In-Check DIAL G16 assist patients to improve their Inhaler technique with pressurised Metered Dose Inhalers?

05 Aug 2021
Respiratory topics
  • Treatment - drug
Type of resource
Dublin 2021
Johanna O Callaghan, HSE, Ireland
Clinical Research Results Aim: Several studies have reported that a high proportion of patients cannot use their inhalers well enough to benefit from the treatment 1, 2.Although study results vary, estimates of inhaler errors include up to 90% of patients using pressurised metered dose inhalers (pMDI’s) 3-5. The aim of my clinical research is to assess if the In-Check DIAL G16 can assist in improving patient’s inhaler technique with pMDI’s by providing objective visual feedback on inspiratory flow rate to patients and healthcare staff. The In-Check DIAL G16 is a cheap hand held device that enables healthcare professionals to coach patients to use their inhalers correctly. The device assesses peak inspiratory flow rate, and can simulate the resistance characteristics of the specific inhalers.Method: Inspiratory flow rate was assessed using the In-Check DIAL G16 on 200 patients with Asthma, COPD and Asthma COPD Overlap (68%, 23% and 9% respectively) who were on at least one pMDI inhaler. Inhaler technique was assessed by the Respiratory Clinical Nurse Specialist (CNSp) at their first consultation and reassessed again at their review visit (Range = 3-6 months). At follow up visits inhaler technique was reassessed by the same CNSp.Results: 100% of the patients assessed at their first consultation had an inspiratory flow rate too fast for optimum clinical efficacy. 80% (n=160) of the patients actually achieved a flow rate > 120 l/min, which is well above the suggested optimum inspiratory flow rate for a pMDI. The ideal ‘clinically effective’ inhalation flow rate should be ‘slow and steady’ (20 - 60 l/min). At the follow up visit 62% (n=124) of patients achieved an inspiratory flow rate within the acceptable flow rate range. All patients agreed that the using the In-Check DIAL and the ‘Slow and Steady’ prompt reminded them about the correct flow rate.Conclusion: Inhaler technique among patients is substandard. This is a key area for primary care staff to become more proactive. The In-Check DIAL is a cheap, valuable and portable tool to assist in improving patient’s inhaler technique. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest References and Clinical Trial Registry Information