Poor turbuhaler technique by community patients

Turbuhalers™ are breath-actuated dry powder devices. Incorrect Turbuhaler use, particularly a non-vertical position during loading, results in reduced drug delivery. This pilot study was designed to assess the frequency of incorrect Turbuhaler technique in community patients. Methods: Patients were recruited from 6 community pharmacies after filling of a Turbuhaler™ prescription. A structured interview was carried out, including a questionnaire about asthma severity, medications and history of Turbuhaler™ instruction. The patient was asked to demonstrate their use of a placebo Turbuhaler™ th their technique being assessed using a standard 9 point checklist (score 9 = correct technique). Results: 15 patients, aged 35 to 80 participated in the study. 7 (47%) were using a Bricanyl Turbuhaler™, 2 (13%) a Oxis Turbuhaler™ and all 15 a Pulmicort Turbuhaler™. The Turbuhaler™ was prescribed by a physician (n=3) or general practitioner (n=12). All 15 patients had last received Turbuhaler use instruction by their prescribing physician at time of initial prescription (range 3 weeks to 10 years). Two patients (13%) also received instructions from their pharmacists at the same time. Three patients (20%) do not recall ever having received instructions on the correct use of their Turbuhaler™. With direct observation of Turbuhaler™ technique, the median score was 7 (range 5-9). Only one patient (7%) had correct Turbuhaler™ technique, with the most common problem being failure to hold the Turbuhaler vertical during loading (14 patients, 93%). Conclusions: This pilot study showed that poor Turbuhaler™ technique is very common in community patients, and may be related to insufficient provision of instruction about correct technique. These findings have major implications for medication delivery.