Asthmatics Suffering 'Because Doctors Can't Understand Inhalers'
Asthmatics are frequently unable to use their inhalers properly because their GPs don't understand the devices themselves, doctors warn today.
They say asthma sufferers including children are ending up in accident and emergency with serious breathing difficulties because they have not been given sound advice on how to use inhalers.Asthma, which affects up to eight million people in Britain, is commonly considered to be a mild condition. But it can be fatal. In 2009, it claimed 1,131 lives one every eight hours. Doctors think nine out of 10 deaths are preventable.
Writing today in the Drug and Therapeutics Bulletin, a British Medical Journal publication, a panel of doctors note that more than half of patients "struggle to use a metered dose inhaler properly".
And they warn: "Of perhaps more concern is the fact that many health professionals also do not know how to use inhalers correctly and are therefore not in a position to coach patients effectively."
One study showed 91 per cent of healthcare professionals who teach patients inhaler use, "could not demonstrate all the recognised steps" in taking inhaled medication.
They continue: "There is a widespread lack of attention with regard to teaching, checking and re-checking inhaler technique."
Dr James Cave, a Berkshire-based GP who also edits the Bulletin, commented: "A lot of patients are getting some of the drug into their lungs, but not as much as they should do."
Studies show that "at best" a third of the drug in a dose gets into a patient's lungs. At worst, none does.
Asthma patients typically have two types of inhaler medication: a 'preventer' drug which stops symptoms starting, and a 'reliever' to bring them under control if they do start.
Dr Cave said poor technique meant patients were less able to control low-level symptoms like wheezing, and more likely to suffer much more serious asthmatic exacerbations that can lead to them being hospitalised.
GPs and surgery nurses are most likely to be the person teaching an asthma patient inhaler technique, he said, although pharmacists are also involved.
However, because they had to be experts of so many conditions, sometimes it meant they were not up to speed with inhaler technique.
"In the last 10 years the need for GPs to be involved in management of chronic disease has just mushroomed," he explained.
Inhalers keep changing - dozens of types available are now available - and Dr Cave said this meant training too often failed to keep pace.
In 2011 the NHS spent £900 million on inhaler medications, almost one per cent of its entire budget. That figure is set to increase as the number of people with chronic obstructive pulmonary disorder (COPD), a respiratory problem mainly caused by smoking, grows.
Dr Cave said it was therefore crucial to address an issue that was resulting in the waste of so much drugs and NHS money.
Pilot projects in the Isle of Wight and Hampshire had showed paying to retrain doctors, nurses and pharmacists reaped dividends, he added.
Dr Dinesh Saralaya, a Bradford-based consultant respiratory physician, said he saw lots of patients whose asthma had got worse because of poor inhaler technique.
"These drugs are expensive," he said. "If the patient is not using the inhaler properly, the whole exercise is defeated."
Dr Clare Gerada, chairman of the Royal College of GPs, said doctors recognised the importance of being able to demonstrate inhaler use correctly, particularly as the devices had changed so much.
"We've actually got an update session on it at the moment at our annual conference in Glasgow," she said. "The idea that we don't have training is not the case."
Stephen Adams - telegraph.co.uk