Unless they have been taught how to use their dry-powder inhalers, patients may not be getting any medication, a German pulmonologist reports.

Siegfried Wieshammer, MD, studied 224 consecutive asthma or chronic obstructive pulmonary disease (COPD) patients who were referred to a clinic in Offenburg. They were asked how they learned to use their inhalers and to demonstrate their technique. Overall, a third of the group (32.1%) did such a bad job that no medication got to their lungs. Dr. Wieshammer presented his findings to the recent American College of Chest Physicians meeting.

There was a direct correlation between training and technique. When a clinician had shown them what to do, three out of four patients (76.9%) used their inhalers correctly. But among those who had to rely only on the brochure included with their devices, more than half (52.6%) failed to receive any medication. Some of them actually exhaled into the tubes.

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Two other variables also had independent effects, Dr. Wieshammer found. Error rates increased with age (20% at age 60 years) and the degree of airway obstruction (25% in normal function vs. 63.6% in severe obstruction). Still, older patients can benefit from dry-powder inhalers, Dr. Wieshammer notes. They just need supervision.