6 MIN READ

The shoe’s on the other foot

In my role as a human factors specialist at Team, I’ve evaluated many drug delivery products with all sorts of different end users. But until very recently I’ve been lucky in that I’ve had never actually had to use any type of medical device on myself.

However, that changed in August this year; having coughed and spluttered my way around the Team office for a few weeks, I was subsequently diagnosed with Pneumonia whilst away in the USA.

After a swift chest x-ray, the Doctor packed me on my way with a prescription for various antibiotics, cough mixtures and my very first personal medical device; a pressurised metered-dose inhaler (pMDI).

Becoming an inhaler user

Becoming an inhaler user

Now even though I’ve studied numerous sets of instructions for use for inhalers and observed many participants using pMDI inhalers during user studies, as I collected my prescription from the Pharmacist I denied all knowledge of my experience and I allowed him to explain how I should use my inhaler just like he would to any patient; after all, it’s always good for us to get more of an insight into what kind of training support patients get in reality and what better way is there than experiencing it first-hand?

That evening, sat in my hotel room, I started at the beginning by reading the leaflet that came with the inhaler. But as I removed the leaflet from inside the carton and opened it up, it felt as though I was opening a map; fold after fold of information in very small print.

I also couldn’t help think that for some new users it must be quite daunting to be confronted with so much information at this stage in their medical device career.

In fact the type was so small, and the paper so thin, that even with the smallest amount of light shining through from behind reading the information was challenging even for my 20:20 vision; how do people with less than perfect vision manage?

I also couldn’t help think that for some new users it must be quite daunting to be confronted with so much information at this stage in their medical device career.

And so at this point I did, what I expect many other patients would do, I promptly ignored all of the information in the leaflet on the side effects and risks associated with using the inhaler as all I wanted to do was to use the inhaler, to gain some relief from my incessant coughing. So I made a bee-line for the information in the leaflet which told me how to actually use my inhaler.

Operating the device

Operating the inhaler was simple enough and just as I’d expected; after priming it for the first time I shook it, exhaled fully, placed the mouthpiece between my lips and created a good seal, breathed in as I pressed down on the canister and then I held my breath for 10-seconds. Simple, well not quite.

It’s well known that one of the main difficulties that patients have when using pMDI type inhalers is coordinating the pressing down of the canister with their inhalation; this is particularly true for adolescents.

If you press the canister too late, little drug gets to the lungs and if you press too early much of the drug ends up in your mouth with a potential increase in side effects.

I know that there will always be variation between different pMDI inhalers designed by different manufacturers, but my recent experience has made me wonder how much consideration is given to how even slight technical differences between devices can impact on successful use by patients.

For the first few days as I pressed the canister and attempted to breathe in at the same time, I’m sure much of the drug hit the back of my throat or the roof of my mouth or the base of my tongue instead of making its way to my lungs as intended. Coordinating inhaling and pressing the canister is tricky and not just for adolescents!

Since returning home to the UK I’ve been given a further two different types of pMDI inhaler and to my surprise they all have slightly different characteristics:

  1. The trigger point at which pressing the canister releases drug is marginally different across all three of my inhalers; this only makes coordinating my breathing with pressing of the canister more difficult.
  2. The speed with which the drug sprays out of the canister appears to differ as well; this may be subjective on my part but again it doesn’t help my coordination attempts.
  3. Because the size and shape of all my pMDI inhalers are different I hold each of them in a slightly different way. This means that the angle of the mouthpiece in my mouth differs across the inhalers as does the ease with which I’m able to hold the inhaler and press the canister in a controlled way.

If you combine all of these aspects together, I find that it’s a bit of a lottery whether I use each of my different inhalers effectively or not!

Getting to grips with the inconsistencies

I know that there will always be variation between different pMDI inhalers designed by different manufacturers, but my recent experience has made me wonder how much consideration is given to how even slight technical differences between devices can impact on successful use by patients.

For me at least, next time I’m in my GP surgery I will ask the Nurse for an inhaler spacer (or an aerosol-holding chamber as they are known) to help slow the delivery of medication from one of my pMDI inhalers in particular and so make delivery more consistent; spacers are more typically given to adolescents, but maybe adults, and in particular newly diagnosed adults, should also get them as a matter of course.

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