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DID YOU PRESCRIBE A
WRENCH TO TURN A SCREW?
THE ROLE OF INHALER
TECHNIQUE IN RESPIRATORY
DISEASE MANAGEMENT
By Mike Hess, BS, RRT, RPFT
Adherence to medication regimens is a well-known, well-
documented issue in chronic lung disease care. The reasons
for this are many; from an inability to afford prescribed
medications, to formulary-related barriers, to ineffective
patient education on devices and dose schedules. For
example, a recent cross-sectional study of nearly 3,000
European patients with COPD found over half were unable
to use their devices correctly, despite having been previously
educated on proper usage 1 . The issue appears at a similar
rate in the asthma population 2 , highlighting the need for
better education. However, even when patients are able to
perfectly execute the steps involved with priming, loading,
and actuating their inhalers, clinicians often fail to consider
their patients’ inspiratory flow characteristics when
assessing technique. This omission can mask the true cause
of treatment plan non-adherence, and prevents clinicians
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from providing effective alternatives.
Fortunately, there are multiple, easy-to-implement strategies
available to evaluate virtually all aspects of inhaler device use.
The InCheck DIAL (Clement Clarke International) is a
reusable inspiratory flow meter that can simulate the internal
resistance of various dry-powder devices on the market. The
clinician sets the resistance range appropriate to the patient’s
device and instructs the patient to inhale maximally on a
disposable mouthpiece. The resulting measurement can be
used to determine if the patient is physically able to generate
sufficient inspiratory flow to disaggregate the powder bolus
into respirable particles. Use of the InCheck DIAL provides
clinicians with customized, patient-specific data that allows for
more informed clinical decision-making without adding
significant time to encounters, and empowers clinicians to
spend their patient education time focusing on the particular
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