By Dr Philip Koopowitz- Dispex & Hexagon6
NICE NG80 resource ‘Asthma inhalers and climate change’ now encourages patients aged 12
years and over where clinically appropriate to consider using dry powder inhalers (DPIs).
The European Respiratory Society’s (ERS) position statement on asthma and the environment
introduces the concept of ‘the green’ patient with asthma, where patients’ inhaler usage and
technique are optimised to ensure that their respiratory symptoms are well controlled. Measures
and education for patients to improve inhaler technique include the prescribing of a suitable inhaler
device, ensuring optimal medication delivery using a spacer, whilst minimising adverse drug interactions.
The greenest inhaler is the one the patient uses effectively to protect and improve their health without
the fear and stigmatism of their carbon footprint.
Many patients may be able to be changed to DPIs, however some asthma and COPD patients will not
have the necessary inspiratory effort to ensure they are able to activate or inhale adequate amounts of
the active ingredients. For these patients, pMDIs with Anti-Static Valved Holding Chambers (AVHCs)
will be the most effective treatment.
- Ideally use an AVHC for ALL patients prescribed an ICS via an MDI but especially for those
on high dose ICS - Use a pMDI + an AVHC (up to 10 puffs) instead of a nebuliser for treatment with beta 2-agonists
in children and adults with mild to moderate exacerbations of asthma - It is important to use the same AVHC device when titrating doses according to clinical response.
A change in an AVHC may alter the effective dose delivered. Remember to check the AVHC
compatibility if changing inhalers. - For children – at every review check spacer/mask to ensure age appropriate
Benefits of Using a AVHC
- More effective treatment: Improved lung deposition, reduced oropharyngeal deposition, and avoids
potential increased systemic side effects following swallowing, may allow a lower dose of ICS to be
effective in controlling asthma - Reduces problems with co-ordination/poor inhaler technique e.g. for the elderly and children
- Useful for treatment of first attacks of wheezing in patients who have NOT used inhalers before.
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