The Pharmaceutical Journal
Vol 270 No 7252 p792
7 June 2003

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  SGM
  New Charter
  CD prescribing
  Asthma
  CFC-free inhaling
  Remuneration
  Branding
  Pharmacy closures
  Yellow cards
  Patient packs
  Penicillin
  The Society

Letters to the Editor

CFC-free inhaling

Remind patients to wash their MDI devices

From Ms E. Gilchrist and others

We write to raise awareness of a problem with chlorofluorocarbon-free salbutamol metered dose inhaler devices which, although recognised by manufacturers, is poorly communicated to patients.

Manufacturers of CFC-free MDIs recommend regular washing of the devices to ensure continued reliable performance, and this information is conveyed in the patient information leaflets supplied with these products.

Anecdotal evidence from patients presenting at respiratory outpatient clinics and from inpatients at the Chelsea and Westminster hospital, suggests that CFC-free salbutamol MDI devices frequently "seize up" or "become blocked", despite an adequate reservoir of drug in the pressurised cannister. These observations indicated a potential problem with the performance and reliability of the devices, prompting further inquiry. A subsequent telephone call to the then Medical Devices Agency elicited an acknowledgement of the problem but no immediate plans for further investigation or action.

Results from a preliminary questionnaire-based audit of Chelsea and Westminster patients suggest that up to 80 per cent of patients using CFC-free salbutamol MDIs may experience problems with their device malfunctioning. The findings appear to be independent of the brand of inhaler. In our experience, these data reflect poor adherence to manufacturers' instructions regarding regular device washing. This seems to be due to a combination of lack of awareness of the advice regarding regular washing of MDI devices, with patients often neglecting to read the PIL, and a failure to appreciate the importance of this advice, given the potentially serious consequences of device malfunction during an exacerbation of airways disease. The majority of patients questioned, favoured direct counselling from a health care professional as the most effective way to deliver this message regarding the importance of regular washing of the MDI devices.

Further studies are under way to evaluate the extent of the problem and this may result in a call for boxed warnings on the outer packaging of these devices. We would strongly encourage all practising pharmacists to take a moment to counsel patients using CFC-free salbutamol MDIs to reinforce the information in the PIL for these devices, clearly demonstrating how to wash the device and how often.

Emma Gilchrist
Preregistration Trainee

Kieran Hand
Clinical Pharmacist

Katey Wilkins
Preregistration Trainee Co-ordinator
Chelsea and Westminster Hospital
London SW10

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