This confusing situation happens often, even when the
rescue and maintenance inhalers are of
different color. The root problem is lack of standardization
among inhalers, with unclear labeling to distinguish between
rescue and maintenance inhalers. A contributing cause is
lack of proper education for both the caregivers and their patients .
All too often proper instructions were not given
when the drug was first prescribed. And even when they are provided,
patients sometimes don't really understand, or they forget.
Either way, having similar inhalers for different purposes
is an invitation to error. (This was less likely to be a problem
when the drug was studied
by the drug companies; see YELLOW BOX above, under 'DPI Type 2'.)
The problem is compounded when patients are on multiple
inhalers, eg, Proventil for rescue, Advair and Spiriva for
maintenance. That's 3 separate devices with two different
purposes -- easy for the patient to get confused. (Pills and
capsules come in many colors and sizes, but they are all
swallowed the same way.) What's needed is a universal delivery
device for all inhalers, with perhaps just two colors:
red for rescue drugs and green for maintenance drugs.
Anyone with clinical interest in the inhaler problems discussed above
(Errors 1 & 2) should definitely read
Problems With Inhaler Use: A Call for Improved Clinician and Patient Education ,
by James B. Fink and Bruck K. Rubin (Respiratory Care, Sept 2005, Vol 50, No. 10,
3. Not checking some objective measurement of the patient's air flow obstruction.
Every patient should have a breathing test to ascertain the degree of
impairment caused by the asthma. The most frequently performed
test is 'spirometry', which takes just a few minutes and requires the
patient to exhale forcefully thru a testing device (shown below).
A patient performing the spirometry test
Graphs from a normal spirometry test; left panel, graph of flow vs. volume; right panel, graph of time vs. volume.
If the device is a modified or enhanced version of a legally marketed device, whether it be modifications in hardware, software, features, accessories, components, or intended use, the discussion should include this information, along with a rational for each modification. If the modifications are being implemented to correct problems, this should also be addressed. If the device comes in a variety of configurations, sizes, or accessories, or is sold with a variety of other components, every configuration or combination should be included in the comparison and 510(k) numbers or proof of preamendment status for components or accessories should be provided.