Editorial
Difficulties With Inhaled Therapy: A Complex Simple Technique
Dificultades en terapia inhalada: la complejidad de lo sencillo
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However, we know that the margin of error of these devices is very wide and many studies have demonstrated that misuse leads to poorer disease control, a greater number of exacerbations and, consequently, increased health and social expenditure.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1–4</span></a> In addition to this problem, poor compliance reduces even further the chances of an effective therapeutic response.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of our obligations in daily clinical practice is to review the inhalation technique (IT) of each patient. The drug is not just a molecule, it is the combination of the molecule and the delivery device.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Diverse circumstances, including the pressure of rising healthcare demands, make it difficult to verify IT in each visit, so alternatives must be sought. One solution is to delegate this aspect of care to nursing staff dedicated to health education in respiratory disease. Some centers are already successfully implementing this practice.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Another possibility may be to increase the involvement of primary care staff, but there are obvious difficulties with this approach, including the heavy care burden of this collective and the diversity of diseases that they manage.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Respiratory health involves several hygiene and dietary measures that should be recommended in each patient visit: smoking cessation, weight loss, physical exercise, IT, etc. Often, however, given the short time available for consultations, these measures are not given the attention they deserve despite being at least as important as pharmacological interventions.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Yet another difficulty emerges in the assessment of IT: what in fact is a correct IT? Many authors have compiled checklists in the attempt to define correct IT, but these publications are at best inconsistent, and at worst contradictory.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">8–10</span></a> Moreover, no consensus has been reached on what constitutes a critical error. At the present time, the most widely accepted definition is that which describes a critical error as one that can affect the effectiveness of the drug administered, leading to suboptimal disease control.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Sanchis et al., in a review published in 2013, aimed to describe the most frequent errors for each of the existing devices but found it difficult to make a useful comparison given the heterogeneity of the different studies analyzed. The final conclusion, therefore, cannot be definitive, making it impossible to precisely define the most common errors.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The difficulties of IT were identified decades ago; however, progress over the past 40 years has been slow and the increasing availability of different devices adds to the complexity of teaching proper techniques.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> Who has never questioned their own ability to explain how an inhaler works? Can you imagine then the difficulties encountered by our patients and even other healthcare professionals who are not respiratory experts?</p><p id="par0045" class="elsevierStylePara elsevierViewall">In addition to the problems involved in the use of each of the current devices (17 in all, including conventional pressurized metered dose inhalers [PMDI], Modulite, Respimat, breath-actuated inhalers [BAI] and 12 other dry powder devices, both monodose and multidose), the patient's individual characteristics also affect the proper performance of the technique. Factors such as age, sex, level of education, number of prescribed inhalers, comorbidities, socioeconomic status, etc., have been studied, but no clear association with poor IT has been demonstrated.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> In this digital age, various smart inhalers and computer applications have been developed in an attempt to solve both the problem of poor IT and the problem of poor compliance,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> although to date these have had little impact on daily clinical practice.</p><p id="par0050" class="elsevierStylePara elsevierViewall">As our knowledge of the pathophysiology of chronic obstructive diseases grows, we try to individualize and create “a la carte” treatments, but some basic errors persist.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Now, more than ever, we need to look for solutions to improve something so simple yet so complex as IT.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Given the socioeconomic impact of these diseases, it is essential that we invest in education in IT from a multidisciplinary perspective, involving at least primary care physicians, nursing staff and pharmacists.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Our priority is to reach a consensus definition on correct IT, thus transmitting a clear and unambiguous message to both patients and other healthcare professionals.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Both pulmonologists and health authorities must make every effort to break through this regrettable 40 years of inertia.</p><p id="par0075" class="elsevierStylePara elsevierViewall">It is time to stop and think, and try to solve the issue of this complex simple technique.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez García C, González F-J, Facal Mayo D. Dificultades en terapia inhalada: la complejidad de lo sencillo. Arch Bronconeumol. 2020;56:416–417.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaler devices: better management or new devices? The blind leading the blind" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Viejo-Bañuelos" 1 => "J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 1 | 2 |
| 2024 October | 50 | 32 | 82 |
| 2024 September | 56 | 21 | 77 |
| 2024 August | 60 | 43 | 103 |
| 2024 July | 50 | 19 | 69 |
| 2024 June | 57 | 28 | 85 |
| 2024 May | 79 | 30 | 109 |
| 2024 April | 30 | 30 | 60 |
| 2024 March | 38 | 20 | 58 |
| 2024 February | 34 | 21 | 55 |
| 2023 March | 8 | 3 | 11 |
| 2023 February | 31 | 22 | 53 |
| 2023 January | 24 | 24 | 48 |
| 2022 December | 49 | 23 | 72 |
| 2022 November | 50 | 36 | 86 |
| 2022 October | 47 | 32 | 79 |
| 2022 September | 39 | 25 | 64 |
| 2022 August | 32 | 30 | 62 |
| 2022 July | 28 | 38 | 66 |
| 2022 June | 30 | 42 | 72 |
| 2022 May | 25 | 26 | 51 |
| 2022 April | 36 | 43 | 79 |
| 2022 March | 45 | 43 | 88 |
| 2022 February | 23 | 14 | 37 |
| 2021 June | 1 | 0 | 1 |
| 2020 October | 1 | 0 | 1 |
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