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Dry powder inhaler switch — GPhC CRA MCQ

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HardRespiratory TherapeuticsDry powder inhaler switchGPhC CRA

An adult with asthma cannot generate sufficient inspiratory flow to use a dry-powder inhaler despite coached technique. Hand strength and cognition are adequate. Which device change is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Use a pMDI with spacer and teach and confirm effective technique

Use a pMDI with spacer and teach and confirm effective technique: A pMDI with spacer does not depend on the high inspiratory flow required by a DPI and can reduce coordination demands when technique is taught and checked. Continue the DPI and coach a slower, longer inspiratory manoeuvre: A slow inhalation further reduces powder de-aggregation when inspiratory flow is already inadequate. Change to a higher-resistance DPI and repeat inspiratory-flow assessment: Greater device resistance may compound the same flow-dependent delivery problem. Use a breath-actuated DPI and retain the existing inhalation technique: Breath actuation does not remove the minimum inspiratory flow needed to disperse a powder dose. Replace inhaled treatment with low-dose oral theophylline and monitor levels: An appropriate inhaler interface should be explored before exposing the patient to systemic treatment with a narrow therapeutic index.

Reference: NICE NG245: asthma diagnosis, monitoring and chronic management: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations; BNF: salbutamol: https://bnf.nice.org.uk/drugs/salbutamol/