December 24, 2014 / 5:30 PM / 3 years ago

Most people use inhalers and auto-injectors improperly

(Reuters Health) – Less than one in five people who need to use asthma inhalers or epinephrine auto-injectors know how to use them properly, a small U.S. study suggests

People with severe allergies or asthma often carry the devices to treat potentially dangerous allergic reactions or to help relieve asthma “attacks.”

Dr. Rana Bonds, who led the study, said the idea for it came from an experience with a patient who drove home while having an allergic reaction because she couldn’t remember how to use her auto-injector and was afraid she’d hurt herself.

“So we did a little informal survey of the patients, and were quite mortified. We found that almost none of them knew what to do,” Bonds told Reuters Health in a phone interview.

“Some of them were trying to inject themselves in places that you don’t want to inject yourself,” said Bonds, an allergist with the University of Texas Medical Branch in Galveston.

“Very few of them knew what to do and so we started thinking maybe this is more of a widespread problem than we ever thought it could be,” she said.

Bonds and her colleagues enrolled 102 allergy patients who used epinephrine and 44 patients who used asthma inhalers from both adult and pediatric allergy clinics.

“We decided to include inhalers as well because there have been some reports in the literature from 10 or 15 years ago that patients often forget how to use those, so we just wanted to see if that was a continuing problem,” Bonds said.

Each of the patients demonstrated how they used the devices and the researchers compared their steps to accepted standards of use and manufacturer’s instructions.

The study team found that only 16 percent of allergy patients used the epinephrine auto injectors correctly. And more than half of the patients who used the injectors incorrectly missed at least three steps.

“The most common error was not holding the unit in place for at least 10 seconds after triggering,” the authors write in the Annals of Allergy, Asthma and Immunology.

Just 7 percent of the asthma patients used their inhalers correctly. Of those who used the inhaler incorrectly, more 60 percent missed at least three steps.

The most common error was not exhaling completely before using the inhaler. Another common problem was not realizing that the “horn-type sound” made by the inhaler is a signal that the inhalation was performed imperfectly.

Men, younger patients and those with medical training were more likely to use the devices properly.

Bonds said she thinks the best thing for asthma and allergy patients to do is to review how to use these devices with their doctors or pharmacists.

“Actually pharmacists do better than the physicians,” she said. “So whenever they go to pick up their refill or just want to stop by because they’re in the drugstore, their pharmacist will be happy to review with them the right way to use them.”

Bonds said the companies that make the epinephrine auto-injectors have videos on their websites that can also help patients see how to use the devices properly.

“As for the inhaler, I don’t know of any particular manufacturer that has a video. There are a couple of YouTube videos out there showing how to use it, but again, I think the best way is probably to just ask their physician or ask the pharmacist,” she said.

Dr. Mark Moss, an allergist with the University of Wisconsin who was not involved in the study, told Reuters Health that he and his colleagues see this problem frequently in practice.

The study “points out the difficulty many patients have using these devices that are potentially life-saving for common conditions,” said Moss.

Moss provides a review of inhaler technique at every patient visit for asthma.

“It’s always very eye-opening when patients show you what they’re doing with their inhalers because many times they’re using them subtly incorrectly,” he said. “So this is a study that is very reflective of real life.”

SOURCE: Annals of Allergy, Asthma and Immunology, online November 18, 2014.

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