Physical ability of people with rheumatoid arthritis and age-sex matched controls to use four commonly prescribed inhaler devices

Background Respiratory disease is a common co-morbidity with rheumatoid arthritis (RA). RA commonly affects the hands, but there is little research investigating whether these patients are physically able to operate inhalers. Aim To compare the physical ability of people with and without RA to use four commonly prescribed inhaler devices (pressurised metered dose inhaler (pMDI), Easi-Breathe ^®, HandiHaler ^® and Turbohaler ^®). Methods Adults with RA and an equal number of age-sex matched controls were observed using placebo inhaler devices. Maximum inhalation flow rate was measured with an In-Check Dial device. Dichotomous data were compared (RA versus control) using Fisher's exact test. Results Thirty four participants were recruited for each group. For all inhalers, fewer participants with RA were able to complete all the steps necessary to operate the device: pMDI (50% vs. 91%), Easi-Breathe ^® (77% vs. 97%), HandiHaler ^® (15% vs. 94%) and Turbohaler ^® (85% vs. 100%). This difference was significant (p <.05) for the pMDI, Easi-Breathe ^® and HandiHaler ^®. Significantly fewer people (p <.05) with RA were able to depress the pMDI canister, or to complete three steps in the operation of the Handihaler ^® (open the dust cap, remove the capsule from its blister, pierce the capsule). Only one participant (RA group) was unable to achieve the minimum flow rates required to operate the Turbohaler ^® and HandiHaler ^® (p = 1.000). Conclusions People with RA have varying physical abilities to use inhalers effectively. A person-centred approach is required to assess which inhaler device is appropriate for each individual patient.