Inhaled flow and handling of fluticasone diskhaler by asthmatic patients

We investigated the inhaled flow and handling of a Fluticasone Diskhaler (FDH) by patients familiar with the beclomethasone dipropionate inhaler (BDI), a metered dose inhaler. Before the FDH was introduced in our hospital, 174 patients were instructed in the use of the Diskhaler and measured the flow of Diskhaler inhalation. Three months after the introduction of the FDH, approximately 95 patients were using them. During their regular visit to the hospital, we checked the patients' handling of FDH and the flow of FDH inhalation (n=81). It was found that only 22% of the patients correctly handled the FDH. The major erros concerned breath-holding and disk rotation after use, but 9.9% of the patients handled the inhaler with serious error, e.g., incomplete puncturing of the blister. The mean FDH flow was 86.5 L/min, which was significantly higher than that recorded at the first FDH trial (69.1 L/min). In 9.9% of the patients, the inhaled flow was inappropriately low (<50 L/min), in 29.6% of the patients, it was unnecessarily high (>100 L/min). In conclusion, handling the FDH is easy for patients who are already familiar with the BDI. However, in 40% of the patients, the inhaled flow rate was not sufficient.