Friday, 03. May 2013

Inhaler training remains a crucial factor...

... in patients with chronic airflow obstruction.

There is agreement that choosing the proper inhalation devices is an important factor for a successful aerosol therapy. Current guidelines for the management of asthma and COPD (chronic obstructive pulmonary disease) do not provide sufficient specific guidance on the selection of the appropriate device. Nebulisers and inhalers are regarded as equally effective. A previous study from the group of Melani showed that in particular elderly patients feel that nebulisers are more effective and therefore they often prefer them. One reason for this could be the incorrect use of metered dose inhalers (MDI) and dry powder inhalers (DPI). Therefore Melani et al evaluated home aerosol practice in a large sample of experienced patients with chronic airflow obstruction (CAO) to investigate this hypothesis.

This cross-sectional, observational study was carried out in 24 hospitals throughout Italy to characterize patients (age 18 or older) who practise home aerosol therapy of chronic airflow obstruction. The project included 1527 patients who were only inhaler users (OIU group, Only Inhaler Use) and 137 patients who were utilizing both, nebulisers and inhalers (NIU group, Nebuliser and Inhaler

OIU group

Only Inhaler Use

NIU group

Nebuliser and Inhaler Use



  • The average age was 67.7 years in the NIU group and 61.1 years in the OIU group (p<0.0001)

  • The mean FEV1 % pred. (Forced Expiratory Volume, predicted; parameter for lung function) was 62.3 in the NIU group and 69.9 in the OIU group (p<0.0001)

  • Higher emergency visits and antibiotic use in the NIU group compared to the OIU group (p<0.001)

  • The majority of nebuliser users (n=61, ntotal=107) perceived nebulisers as more effective than inhalers

  • The percentage of OIU patients reporting to receive instruction at first inhaler prescription was greater than that of NIU patients (85 % vs. 65 %; p<0.001)


Table 1: One question of the inhaler survey: The majority of the users in the NIU group perceived nebulisers as more effective than inhalers (MDIs and DPIs). 107 patients were interviewed.


A subset of Italian patients with chronic airflow obstruction was regularly using home nebulisers. These patients often had more severe respiratory conditions, advanced age and common inhaler mistakes with DPIs and/ or MDIs. In patients using both, nebulisers and inhalers, the frequency of inhaler mistakes remained very common compared to those who only use inhalers. The author suggests that this group requires more education for improving inhaler technique. Older and severely ill patients who are not able to use inhalers correctly despite proper education, should be considered for nebuliser therapy.

Melani et al., Respir Med. 2012 May;106(5):668-76