LAUSR

Inhaled therapy is very useful for administering drugs for asthma and chronic obstructive pulmonary disease (COPD). Its efficacy is associated with the amount of drug directly deposited in the airway, which in turn depends on the type of administration device and dosing technique used, i.e., the maneuvers required for the release and inhalation of the indicated dose must be performed correctly. Health professionals need to be familiar with the available devices, their characteristics and procedures, critical issues associated with their use, and the instructions they must give their patients.1 The pressurized metered dose inhaler (pMDI) was introduced in the 1960s and quickly became the preferred pocket inhaler of both doctors and patients. Despite its apparently easy and intuitive technique, the inhaler has always been susceptible to misuse. In Spain, the earliest studies2–4 revealed that fewer than 30% of patients used it correctly. Subsequent studies confirmed that incorrect use was still a problem. A Spanish multicenter study published in 1998 showed that pMDIs were used correctly by only 9% of 746 patients, 15% of 446 nurses, and 30% of 428 physicians.5 Fourteen years later, in 2012, the same level of ignorance persisted among health professionals.6 Dry powder inhalers (DPI) were developed, in part, to eliminate the coordination difficulties associated with the pMDI; however, experience has shown that these devices also present problems for many patients. The defective use of inhalers is a serious clinical problem, since it hampers disease control in asthma7 and increases the frequency and severity of exacerbations in COPD. A recent review of errors in inhalation technique8 found that at least 1 in 3 patients makes critical mistakes in 1 or more of the required maneuvers, thus delivering very little or no medication in each puff. The situation has remained unchanged for more than 40 years, since pMDIs and DPIs