geoffrey modest medical blogs

  I heard an impressive segment on NPR on May 6 about the rather extensive potential environmental damage done by asthma/COPD inhalers that use a propellant (the boot-shaped inhalers):  https://www.npr.org/sections/health-shots/2024/05/06/1248504466/could-better-asthma-inhalers-help-patients-and-the-planet-too  . This segment highlighted Dr. Miguel Divo, a pulmonologist in Boston, who is a strong advocate for using dry powder inhalers (DPIs) instead of the environmentally toxic ones using a propellant gas, now hydrofluoroalkanes (HFAs).   Details : From a 2021 report by the US environmental protection agency ( https://www.epa.gov/sites/default/files/2021-03/documents/epa-hq-oar-2021-0044-0002_attachment_1-mdis.pdf  ):     -- the pharmaceutical industry initially used chlorofluorocarbons (CFCs) as the propellant in metered dose inhalers (MDIs), though these were phased out and fully replaced by hydrofluoroalkanes (HFAs) by 2014    ...

A recent systematic review looked at articles on patient inhaler technique over the past 40 years, finding that 1/3 of users had poor technique, and that number has not changed over these 4 decades (see  asthma inhaler errors chest2016  in dropbox, or Sanchis J. Chest 2016; 150(2): 394). details: --144 articles from 1975-2014 reported on  54,354 subjects performing 59,584 observed tests of technique, from 31 countries around the world --54 studies reported on asthma, 14 on COPD, and 76 on both or unspecified. --mean age of adults was 54, and of children was 9. --results for  most frequent errors :     --metered-dose inhalers (MDI): problems with full expiration in 48%, coordination 45%, speed and/or depth of inspiration 44%, and no postinhalation breath-hold in the 5-10 second range 46%     --breath-activated MDIs: problems with full expiration in 32%, ​speed and/or ...