How can I effectively educate patients about the proper use of inhalers and the importance of adherence to their asthma management plan?

To effectively educate patients about the proper use of inhalers and the importance of adherence to their asthma management plan, several key strategies should be employed:

• Educating on Inhaler Technique:
  • Provide comprehensive information about their inhaler treatments, including the medicines they contain, how they work, when they should be taken, and the correct technique for each device ².
  • Only prescribe inhalers after patients have been trained to use them and can demonstrate satisfactory technique ³.
  • Observe the person using their inhaler device (and spacer if used) to check they can use it properly ¹,². This check should occur at every asthma review (routine or unscheduled), at every asthma-related consultation, when asthma control deteriorates, when the inhaler device is changed, or when the person asks for it to be checked ¹,².
  • If a person is assessed as being unable to use a device properly, even after several repeats of training, provide them with an alternative device ¹,². The choice of inhaler device should be individualized based on the person's ability to use it, considering factors like physical dexterity, coordination, inspiratory flow, and cognitive status ¹,².
  • A spacer should usually be prescribed for use with a pressurized metered-dose inhaler (pMDI), particularly in children, as they improve drug delivery to the lungs and can reduce local adverse effects ¹,². Advise patients on proper spacer cleaning (monthly, hand wash with detergent, air dry) and replacement every 6–12 months ¹,³.
  • Where more than one inhaler is needed, if possible, prescribe the same type of device for both preventer and reliever treatments to reduce confusion and the risk of incorrect technique ¹,².
  • Utilise patient resources such as the Asthma and Lung UK website, which offers short videos on how to use different inhaler types, and the Beat Asthma website, which provides information sheets and videos for children ¹.
• Promoting Adherence to the Asthma Management Plan:
  • Recognise that suboptimal adherence and inhaler technique are common reasons for uncontrolled asthma, with up to 80% of patients having poor technique and about 50% failing to take medication as directed ¹,². Poor adherence increases the risk of uncontrolled asthma, exacerbations, and adverse effects ¹.
  • Provide the person with a personalised asthma action plan (PAAP) and ensure it is reviewed at every asthma-related healthcare attendance and at annual review ¹.
  • The PAAP should be based on symptoms (especially for children) or peak expiratory flow (PEF), or both ¹.
  • Advise patients about their individualized triggers for asthma symptoms and exacerbations, and how to minimise exposure where possible ¹.
  • Educate patients on how to recognise early signs of an asthma exacerbation, what action to take (including specific instructions about changes to reliever and/or maintenance medications, and when and how to use oral prednisolone if needed), and when and how to seek urgent medical attention ¹.
  • Monitor asthma control at every review, checking for time off work or school due to asthma, amount of reliever inhaler used, number of oral corticosteroid courses, and any hospital admissions or emergency department attendances due to asthma ².
  • Encourage people to take their used or expired inhalers to their pharmacy for disposal ¹,².
  • Emphasise that asthma self-management has been shown to increase medication adherence, improve asthma symptom control, and reduce hospital admission rates, unscheduled clinic visits, and mortality rates ¹.