Critical errors found during metered dose inhaler technique demonstration by Pharmacists.

It is extremely important to demonstrate the standardized recommended technique (Adnan et al., 2015) of metered dose inhaler to the patients. Many studies have found critical errors made by pharmacists during demonstration of metered dose inhaler technique (Adnan et al., 2015, Osman et al., 2012, Lenney et al., 2000). The critical errors are those missing steps that have significant effect on aerosol drug delivery (Osman et al., 2012, Lenney et al., 2000). Missing these critical steps can lead to either little or no drug delivery to the target point (Lenney et al., 2000). Moreover, many studies have shown that as many as 25% of patients with asthma and COPD have never received verbal inhaler technique instruction (Javorini et al., 2008).

The following critical steps have been found missing by pharmacists during demonstration of metered dose inhaler technique (Adnan et al., 2015, Osman et al., 2012, Lenney et al., 2000).

Shake inhaler and remove the cap.

Insert the mouthpiece into mouth between closed lips.

Actuation in the first half of inhalation and at the same time breathe in slowly for deep inhalation.

Hold breath for 10–15 s.

These critical errors have been associated with increase in emergency visits, and worsening asthma (Giraud and Roche, 2002). Pharmacists are ideally positioned to teach inhaler technique as they are the last health-care providers however; they should review their inhalation technique and must be fully aware of appropriate recommended steps of using metered dose inhaler.