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article imageAsthma and allergy sufferers misusing inhalers and auto-injectors

By Karen Graham     Dec 20, 2014 in Health
A new study on the proper use of lifesaving inhalers and auto-injection devices for asthmatics has yielded some very surprising results. The study shows the need for better training of patients in the use of these medications.
Nothing can be more frightening to an asthmatic than to not be able to breathe. The same feeling can affect someone with allergies having an allergic reaction. In either instance, lifesaving medications, either an inhaler or an auto-injector containing epinephrine is needed. But according to a new study, an amazingly small percentage of these patients know how to use their devices, and this can sometimes lead to tragic results.
The study, Misuse of medical devices: a persistent problem in self-management of asthma and allergic disease, was published online Dec. 18 in the journal Annals of Allergy, Asthma and Immunology. Co-author Dr. Aasia Ghazi, with Allergy and Asthma Specialists of Dallas said, "This isn't a new concern. We always worry about our patients, especially those with food allergies."
Epinephrine auto-injectors are made for emergency use when having a severe allergic reaction. Screen...
Epinephrine auto-injectors are made for emergency use when having a severe allergic reaction. Screengrab from a video demonstrating the proper use of Epipen,
Dr. Ghazi and her associates recruited 102 patients prescribed epinephrine, and 44 patients prescribed asthma inhalers and spacers for their study. Eleven percent of the epinephrine users had used the devices before. Eighty percent of the asthma sufferers had used their inhalers or spacers before. The inhaler is also called a metered-dose inhaler or MDI.
The volunteers demonstrated to the researchers how they used their inhalers or auto-injectors for epinephrine. Only 16 percent knew how to use an epinephrine auto-injector on themselves or someone else having a life-threatening allergic reaction. Worse still, only seven percent knew the correct way to use an inhaler.
"We had a patient call in the middle of a reaction, and she didn't remember how to use the epinephrine injector. That's why we looked to see what's going on, and what are the barriers that keep patients from using these devices properly?" Ghazi explained.
Most state health departments have online video instructions on the proper use of an inhaler  includ...
Most state health departments have online video instructions on the proper use of an inhaler, including how to use a spacer.
UtahDepOfHealth / screengrab
In the study, of the 84 percent misusing the epinephrine auto-injector, over 50 percent missed three or more steps involved in administering the shot. The most common error was not leaving the needle in for at least 10 seconds, a critical mistake. "We instruct patients to leave the unit in place for 10 seconds to make sure 100 percent of the medication is injected," Ghazi said.
Studies have shown that anaphylaxis, a life-threatening allergic reaction, is becoming more prevalent. Dr. Rana Bonds, the lead author of the study, said: “Most patients made multiple mistakes and would not have benefited from self-administration of the potentially life-saving treatment if the need arose.”
According to the study, of the 93 percent misusing inhalers, two-thirds missed three or more steps, the most common error being failure to exhale before depressing the canister to inhale the medication. Not using an inhaler properly means the patient may not be getting the full measured dose, While this is not as bad as misusing an auto-injection of epinephrine, they won't get the effective amount of medication needed.
Researchers found that time was a critical factor in using a device properly, and it had to do with a patient's memory. Those prescribed an auto-injector within a year had 10 percent retention of the instructions on the proper use. Percentages fell dramatically the longer a patient had the prescription. For those patients prescribed an auto-injector for five-or-more years prior, the retention of instructions dropped to only one percent.
Dr. Jennifer Appleyard is chief of allergy and immunology at St. John Providence Health System in Detroit, Michigan. While not involved in the study, she points out the importance of continued reinforcement of instructions for the devices every time a patient sees the doctor. "And, it's not enough to just give instructions. People need to show me how they use the device," she added.
The study clearly shows the need for regular retraining in the use of these medical devices. There are videos online that give clear instructions on the use of inhalers, including the use of spacers, and auto-injection devices. One video, How To Use an EpiPen, is produced by Nationwide Childrens Hospital is an excellent short film. For asthmatics using inhalers, How to use Metered Dose Inhaler (MDI) is a short, clear informational video worth watching.
More about asthma sufferers, inhalers, autoinjectors, Anaphylaxis, reinforcement of steps
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