Do you know when the inhaler is empty?

I Fullwood; T Evans; Benjamin Davies; T Ninan; C Onyon; J Clarke; Rajesh Srikanthiah; Susan Frost; N Iqbal; M Atkinson; Satish Rao; Prasad Nagakumar

doi:10.1136/archdischild-2022-324027

Do you know when the inhaler is empty?

Arch Dis Child. 2022 May 12:archdischild-2022-324027. doi: 10.1136/archdischild-2022-324027. Online ahead of print.

Authors

I Fullwood¹, T Evans¹, Benjamin Davies¹, T Ninan², C Onyon³, J Clarke⁴, Rajesh Srikanthiah⁵, Susan Frost¹, N Iqbal⁶, M Atkinson⁷, Satish Rao¹, Prasad Nagakumar^{8

9}

Affiliations

¹ Department of Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
² Department of Paediatrics, University Hospitals of Birmingham NHS Trust, Birmingham, United Kingdom, Birmingham, UK.
³ Department of Paediatrics, Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
⁴ Department of Paediatrics, Wye Valley NHS Trust, Hereford, UK.
⁵ Department of Paediatrics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
⁶ Department of Paediatrics, Walsall Hospitals NHS Trust, Walsall, UK.
⁷ Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
⁸ Department of Respiratory Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK p.nagakumar@nhs.net.
⁹ Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.

PMID: 35551051
DOI: 10.1136/archdischild-2022-324027

Abstract

Background: Medication review is recommended at asthma appointments. The presence of propellant in the metered dose inhalers (MDIs) makes it challenging to identify when the inhaler is empty. The COVID-19 pandemic has resulted in move towards more virtual monitoring of care. We aimed to evaluate if patients identify when the inhaler is empty and the method of inhaler disposal.

Methods: Prospective, multicentre quality improvement project. Data collected from children with asthma and other respiratory conditions.

Outcome measures: Children/carers attending hospital were asked how they identify an empty salbutamol inhaler; dose counters in the preventer inhalers and disposal practices were reviewed.

Results: 157 patients recruited. 125 (73.5%) patients deemed an empty inhaler as either full/partially full. 12 of 66 (18.2%) preventer inhalers with a dose counter were empty. 83% disposed their inhalers in a dustbin.

Conclusions: Patients cannot reliably identify when their MDI is empty. There is an urgent need for improving inhaler technology and providing appropriate guidance on how to identify when an MDI is empty.

Keywords: Data Collection; Paediatrics; Respiratory Medicine.