Chest
Volume 117, Issue 2, February 2000, Pages 542-550
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Reviews
Inhaled Corticosteroids for Asthma Therapy: Patient Compliance, Devices, and Inhalation Technique

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Background

Patient compliance, inhalation devices, and inhalation techniques influence the effectiveness of inhaled medications.

Methods

This article presents the results of a systematic literature review of studies measuring compliance with inhaled corticosteroids, measuring inhalation technique with different inhalation devices, and estimating the proportion of inhaled drug that is deposited in the lung.

Results

Overall, patients took the recommended doses of inhaled medication on 20 to 73% of days. Frequency of efficient inhalation technique ranged from 46 to 59% of patients. Education programs have been shown to improve compliance and inhalation techniques. The lung deposition achieved with different inhalers depends on particle size as well as inhaler technique.

Conclusion

This review demonstrates that multiple factors may come between a prescription of an inhaled corticosteroid and the arrival of that medicine at its target organ, the lung.

Section snippets

Materials and Methods

The literature review started with a thorough key word search of the National Library of Medicine's MEDLINE database for articles on inhaled asthma therapy published between January 1966 and 1997. We examined the abstracts of these articles and identified articles that presented the results of studies of compliance, inhalation technique, and lung deposition of inhaled asthma drugs. We obtained these articles and examined their references for any other articles pertaining to these issues. We

Compliance

Table 1 shows the results of studies that used an electronic measuring device to estimate compliance with ICSs in asthma patients. Overall, patients took the recommended doses of medication on 20 to 73% of days. The percentage of underuse days ranged from 24 to 69%. Overuse (2 to 23%) is much less frequent than underuse. Average compliance, measured as the ratio of the doses taken to those prescribed, ranged from 63 to 92%. The 92% compliance was observed in a study by van der Palen et al16 and

Discussion

In this paper, we examined three factors influencing the effectiveness of asthma treatment with ICSs in practice—patient compliance, inhalation technique, and lung aerosol deposition. We found that only a small percentage of the prescribed dose of an ICS is likely to reach the target organ, the lung, because of patient noncompliance with the prescribed dose, difficulty in correct use of the inhaler, and the ability of a properly used inhaler to deliver the drug to the lung.

As with any chronic

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  • Cited by (0)

    Research support was provided by Merck & Co. to Dr. Bala, Ms. Downs, and Dr. Mauskopf. Dr. Ben-Joseph is an employee of Merck & Co. Dr. Bala was employed at Research Triangle Institute when the article was written.

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