Reasons for Unintentional Noncompliance

Apart from forgetting the function of the two (or more) inhalers, patients will also forget to take their inhaler on occasion. In a study of parents of asthmatic children (33), 60% said they sometimes forget to give their child s medicine. Indeed, it seems a normal human characteristic to forget to take medicine on occasion. It will only be the exceptional patient who takes medicine exactly as instructed every day without fail. An absence of clear instructions in the self-management plan about what to do when a dose is forgotten is an important omission. 

The physiological effect of forgetting to take a dose will vary with the patient. For patients whose inflammation is barely controlled by the regnlar dose. 

Difficulties in the way patients use MDIs has been one factor in the development of other forms of inhaler, in particular dry-powder inhalers (DPIs) and breath-actuated MDIs. These newer devices produce better compliance in terms of techrfique (whether they affect other reasons for noncompliance is less clear), but even here, some are better than others. One study of dry-powder inhaler technique found that that 5% had good technique, 5% were adequate, and 27% were insufficient (39). For example, in the case of DPI, it is necessary to inhale reasonably fast, though the extent to which the rate of inhalation affects deposition varies between inhalers. Some DPIs show less variation and are tolerant of lower inhalation rates compared with others. The wide range of inhalers now available varies on a number of different criteria, and some inhalers will be more suited to some patients than others. Devices may not be equally suited to children, young adults, or the elderly. 

Checking of technique can take place in the clinic and normally provides a reasonably accurate estimate of the patient s technique when at home. Because 

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