Thread by @PrasadNagakumar

Do you know when your MDI inhaler is empty? HCPs – do we inform children/adults how to identify when the MDI inhaler is empty?.On #WorldAsthmaDay here is a🧵@asthmalunguk @BTSrespiratory @RespNprang @ginasthma @NACAPaudit @RCPhysicians (1/11)

Please read the thread discussing this issue and the results of a QI project (2020-21) by the West Midlands Paediatric Severe Asthma Network @IzziFull @jayneclarkewvt @BwchResp @themfrosts Satish, Teresa @drpaulwatson @EmmaHaribo @Benjami62436784 and many others (2/11)

Metered dose inhalers contain a propellant along with the active drug expel labelled number of actuations (3/11) @RCPCHtweets @rcgp @DFTBubbles @RCollEM

Manufacturers have incorporated dose counters into some inhalers to enable patients to identify the number of remaining actuations. However, Salbutamol (Ventolin®, Salamol®) in the UK has no dose counter.Patients have to ‘remember’ the doses actuated! (4/11) @GSK @NACAPaudit

We asked 157 children/parents prescribed inhalers – how do they identify when their inhaler is empty? (5/11)

So is the dose counter the answer? 12/66 (~20%) preventer inhalers with a dose counter brought to the clinic appointment were empty!.Patients were still using them as a ‘spray was coming out’ or ‘click heard on shaking’ and they did not want to waste the inhaler!(6/11) @AUKCAR

Patient information leaflet (PIL)of the inhalers provide very little information. Also, the inhaler technique’ pictures do not show a spacer!. BTS/SIGN,NICE guidelines do not provide information regarding this too (7/11)@GSK @ChiesiGroup @AstraZeneca @NICEComms @BTSrespiratory

>80% of patients in our QI project had a good inhaler technique and were carrying the right spacer device! All 12 patients with empty preventer inhaler had good inhaler technique and were using the right spacer device (8/11) @inhalers4u @UKInhalerGroup @bigcatdoc

Majority of patients disposed their inhalers in general waste (9/11) @PCRSUK @veena1992 @NHSEngland

Is there any medical condition where the drug recommended to be used to relieve the acute symptoms may not necessarily contain the medicine and patients using them are not actually aware of this? We can do better! (10/11) @MHRAmedicines asthma.org.au/about-us/media…

Along with personal asthma plan, inhaler technique and using appropriate spacer device, discuss the dose counters and identifying when the inhaler is empty as part of basic (essential) asthma care(11/11) @asthmalunguk @RespNprang @NACAPaudit