The potential of a 2Tone Trainer to help patients use their metered-dose inhalers.

School of Pharmacy, University of Bradford, Bradford BD7 1DP, UK.
Chest (Impact Factor: 7.48). 06/2007; 131(6):1776-82. DOI: 10.1378/chest.06-2765
Source: PubMed


Many patients have problems using the correct inhalation technique when they use their metered-dose inhalers (MDIs). We have investigated whether a training aid (2Tone Trainer [2T]; Canday Medical Ltd; Newmarket, UK) helps to maintain the correct inhaler technique after patients leave the clinic
Ethics committee approval was obtained, and patients gave consent. Asthmatic patients who had been prescribed an MDI had their inhalation technique assessed. Their peak inhalation flow (PIF) when using their MDI, FEV(1), and the Juniper asthma quality of life questionnaire (AQLQ) score were measured. Those patients using the recommended MDI technique were the good-technique (GT) group. The remainder were randomized to receive verbal training (VT) or VT plus the 2T to improve their MDI technique. All patients returned 6 weeks later.
There were 36, 35, and 36 asthmatic patients, respectively, who completed the GT, VT, and 2T procedures. FEV1 did not change within all groups between visit 1 and 2. PIF and AQLQ score did not change in the GT group. In the VT and 2T groups, the AQLQ score increased by mean differences of 0.33 (95% confidence interval [CI], 0.14 to 0.53; p < 0.001) and 0.74 (95% CI, 0.62 to 0.86; p < 0.001). At visit 1, all patients in the VT and 2T groups inhaled > 90 L/min decreasing to 12 patients and 1 patient, respectively, at visit 2 (p < 0.001 both groups). The overall changes in the 2T group for PIF and AQLQ score, between visits 1 and 2, were significantly (p < 0.001) greater than the corresponding changes in the VT group.
The 2T helps patients to maintain the recommended MDI technique posttraining with improvements in AQLQ score.

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    • "A checklist to identify critical errors, which are those comprising treatment efficacy, could be applied here, as outlined by Molimard and Le Gros [110]. Examples of currently available tools to objectively check and maintain the correct inhalation pattern include the Aerosol Inhalation Monitor (Vitalograph Ltd., Buckingham, UK) and 2Tone Trainer (Canday Medical Ltd., Newmarket, UK) for MDIs and the In-Check Dial (Clement Clarke International, Harlow, UK) for DPIs [111, 112]. These tools can provide an objective evaluation of the inhalation profile but cannot assess the patient's preparation and handling of their device. "
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    ABSTRACT: The number of people with asthma continues to grow around the world, and asthma remains a poorly controlled disease despite the availability of management guidelines and highly effective medication. Patient noncompliance with therapy is a major reason for poor asthma control. Patients fail to comply with their asthma regimen for a wide variety of reasons, but incorrect use of inhaler devices is amongst the most common. The pressurised metered-dose inhaler (pMDI) is still the most frequently used device worldwide, but many patients fail to use it correctly, even after repeated tuition. Breath-actuated inhalers are easier to use than pMDIs. The rationale behind inhaler choice should be evidence based rather than empirical. When choosing an inhaler device, it is essential that it is easy to use correctly, dosing is consistent, adequate drug is deposited in both central and peripheral airways, and that drug deposition is independent of airflow. Regular checking of inhalation technique is crucial, as correct inhalation is one of the cornerstones of successful asthma management.
    08/2013; 2013(1635):102418. DOI:10.1155/2013/102418
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    • "This sample size will also allow us to detect a minimal important difference of .5 on the AQLQ [113,142], using the Mini-AQLQ a difference as large as 0.97 (SD .61) was found to be clinically meaningful and significant [114,143-145]. "
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    Trials 12/2011; 12:260. DOI:10.1186/1745-6215-12-260 · 1.73 Impact Factor

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