Inhaled medication has been the cornerstone of therapy in obstructive lung diseases for more than a decade. The initial enthusiasm for pressurized aerosol delivery systems has been tempered by the realization that not all patients are able to use such devices adequately. In one of the earliest reports, Saunders found that 11 of 46 patients used their aerosol inhalers incorrectly, resulting in little or no response to bronchodilator. Orehek and colleagues2 found that the inhalation technique was suboptimal in 15 of 20 patients. A study by Epstein and colleagues noted that only 98 of 130 patients could perform as many as 6 of 11 inhaler handling steps correctly. Subsequent studies have confirmed the earlier reports as well as noting an increased frequency of problems in optimal use of aerosol devices in the elderly.”
To address such problems, alternative delivery systems for inhaled medication have been developed. Add-on spacer devices can improve the ability to use an inhaled device, but they are somewhat cumbersome to carry. Dry powder delivery systems are also widely available and seem to be as effective as aerosols when used appropriately.” One such device is the multidose dry powder Diskhaler system itat on http://birthcontroltab.com. This device allows the inhalation of medication when the patient uses it to puncture one of eight blisters of prepackaged drug on a metal foil disk. A presumed advantage of the system is the ability to track accurately the number of doses administered each day.
Published studies evaluating efficacy, performance, and adverse effects of inhaled bronchodilators and their delivery systems have generally been conducted under tightly controlled conditions in small numbers of carefully selected subjects. Studies under such conditions may fail to reveal potential problems when the device is used under less than ideal clinical conditions in large numbers of patients. For this reason, large surveillance studies are needed to detect and subsequently correct problems in usage.
The following report documents the findings of a community-based surveillance study involving 414 physicians and more than 4,000 patients. The objectives of this study were to evaluate the safety, acceptance, and ability to use the albuterol multidose dry powder inhaler under realistic clinical conditions.