“Trying, But Failing”: The Role of Inhaler Technique and Mode of Delivery in Respiratory Medication Adherence

Fulvio Braido, Henry Chrystyn, Ilaria Baiardini, Sinthia Bosnic-Anticevich, Thys van der Molen, Ronald J. Dandurand, Alison Chisholm, Victoria Carter, David Price, Respiratory Effectiveness Group

Research output: Contribution to journalArticlepeer-review

86 Citations (Scopus)
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Inhaled therapies are the backbone of asthma and chronic obstructive pulmonary disease management, helping to target therapy at the airways. Adherence to prescribed treatment is necessary to ensure achievement of the clinician's desired therapeutic effect. In the case of inhaled therapies, this requires patients' acceptance of their need for inhaled therapy together with successful mastery of the inhaler technique specific to their device(s). This article reviews a number of challenges and barriers that inhaled mode of delivery can pose to optimum adherence—to therapy initiation and, thereafter, to successful implementation and persistence. The potential effects on adherence of different categories of devices, their use in multiplicity, and the mixing of device categories are discussed. Common inhaler errors identified by the international Implementing Helping Asthma in Real People (iHARP) study are summarized, and adherence intervention opportunities for health care professionals are offered. Better knowledge of common errors can help practicing clinicians identify their occurrence among patients and prompt remedial actions, such as tailored education, inhaler technique retraining, and/or shared decision making with patients regarding suitable alternatives. Optimizing existing therapy delivery, or switching to a suitable alternative, can help avoid unnecessary escalation of treatment and health care resources.
Original languageEnglish
Pages (from-to)823-832
Number of pages10
JournalThe Journal of Allergy and Clinical Immunology: In Practice
Issue number5
Early online date30 Aug 2016
Publication statusPublished - Sept 2016

Bibliographical note

Recognition of Commercial Support: The Expert Adherence Panel Meeting from which the concepts presented in this article were first discussed and the manuscript submission costs were supported by the Respiratory Effectiveness Group.


  • aherence
  • implementation
  • initiation
  • persistence
  • inhaler device
  • inhaler technique
  • patient preference


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