Complex Inhalers Potentially Compromise Treatment Adherence, Study Finds

Rheumatoid arthritis (RA) patients with comorbidities like chronic obstructive pulmonary disease (COPD) or asthma are struggling to manage their respiratory condition because their inhalers are too complex, researchers at England’s University of Bath reported.

The study, “Physical ability of people with rheumatoid arthritis and age-sex matched controls to use four commonly prescribed inhaler devices,” was published in the journal Respiratory Medicine.

It is estimated that more than 60,000 people in the U.K. live with both RA and a lung disease. Arthritis often affects the hands, making complex or finely controlled actions difficult and even painful, like using an inhaler.

Researchers evaluated the use of commonly prescribed inhalers among adults with RA and an equal number of age- and sex-matched controls. Each arm of the study (active treatment and control) recruited 34 participants.

Four commonly prescribed inhaler devices were tested: pressurized metered dose inhaler (pMDI), Easi-Breathe, HandiHaler, and Turbohaler.

Researchers found that people with RA are less likely to be able to operate inhalers properly. The Easi-Breath and HandiHaler were particularly difficult to use, while the Turbohaler was less problematic.

For all inhalers tested, fewer people with RA were able to complete all the steps necessary to operate the devices. Only 15% of patients could complete all the steps to use the HandiHaler, deemed the most difficult to use among all participants, whereas 94% of the control group were able to use it.

The HandiHaler requires seven steps to be operated properly, including removing a capsule of powered medicine from a foil blister pack, inserting it into the inhaler, and piercing it for inhalation.

Comparatively, 85% of RA patients and 100% of the control group could correctly use the Turbohaler, which has three easier steps: unscrew a cap, twist a dial, and replace the cap.

“These results show how important it is that health professionals make sure people can use any inhaler they prescribe. If someone gets home from a pharmacy with a new inhaler and finds they can’t use it, their lung disease will not be properly treated and the NHS [National Health System] loses money,” Matthew Jones, co-author of the study, said in a press release.

“This simple training makes a real difference to how these patients can manage their respiratory disease. The consequences of not being able to physically operate an inhaler can be severe for patients,” he said.

“Pharmacists, doctors and nurses need to make these easy checks not only help patients achieve better outcomes but also reduce demand on the NHS,” Jones added.

Reportedly, in 2017 4.5 million HandiHalers were dispensed through the National Health Service in England alone to approximately 375,000 people. The effort cost about £135 million British pounds (about $188 million U.S.).

“Some of these inhalers are prescribed by the millions around the U.K., so I was shocked to see the difference in how difficult patients find some types to use,” said Yasmin Shirmanesh, co-author of the study.

“If an inhaler can’t be used properly it’s no good for the patient, and a waste of money for the NHS,” she said.

“No-one wants to see patients struggle needlessly to take the medicines they need to manage serious conditions, so I hope that our study will lead to change in how inhalers are prescribed,” Shirmanesh added..

According to the team, a tailored approach is needed when choosing which inhaler device is appropriate for each individual patient.