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Clinical Investigations: ASTHMA |

Patient Handling of a Dry-Powder Inhaler in Clinical Practice*

Stanley Epstein, MD; Ari Maidenberg, BSc; David Hallett, MSc; Kay Khan, RN; Kenneth R. Chapman, MD, MSc
Author and Funding Information

From The Asthma Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.

Correspondence to: Stanley Epstein, MD, Toronto Western Hospital, 399 Bathurst Street, EC 4–022, Toronto, Ontario, M5T 2S8, Canada



Chest. 2001;120(5):1480-1484. doi:10.1378/chest.120.5.1480
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Background: Multi-dose dry-powder inhalers are perceived as being easier for patients to use than conventional pressurized aerosol inhalers; however, no study has determined whether patients handle such devices adequately and whether there is a need for patient education in this area.

Method: We used trained observers to assess the handling of a specific multi-dose dry powder inhaler (Turbuhaler; AstraZeneca Canada; Mississauga, ON) by patients currently using the device for the management of their asthma. Fourteen discrete steps were scored independently by two observers simultaneously. Patients were divided into two groups for analysis: those who had received formal instruction in the use of the inhaler at The Asthma Centre and those who had received no formal instruction in the community.

Results: There was no significant difference between the formally trained groups and control groups in the percentage of handling steps performed correctly (79% vs 78%, respectively; p > 0.05). Fewer than 50% of patients in both groups demonstrated optimal breath-holding when using the device.

Conclusion: Patient handling of Turbuhaler was generally good, with no evidence that a structured education intervention offered an advantage over the usual education incidental to the prescribing or dispensing process. The most common handling flaw, suboptimal breath-holding, is not specific to this device and is of uncertain clinical significance.


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