Table 2

Common errors in the usage of different inhalation devices

Turbuhaler	HandiHaler/Accuhaler	pMDI	Respimat
Cover is not removed or not covered properly.	Cover is not removed or not covered properly.	Cover is not removed or not covered properly.	Cover is not removed or not covered properly.
Dose is reduced due to patients shaking or tilting the device during preparation.	–		The device is not installed correctly before use.
Device is not held upright.	–	Device is not held upright.	–
Patient does not twist grip at the base or twist around and then back until click is heard.	–	–	Patient does not turn the device towards the arrow in the label until it clicks.
Inhalation force is insufficient.	Inhalation force is insufficient.	Patient does not inhale deeply and slowly.	Patient does not inhale deeply and slowly.
Patient does not tilt his/her head to make his/her chin slightly upturned.	Patient does not hold his/her head in a vertical position.	Patient does not tilt his/her head to make his/her chin slightly upturned.	Patient does not point the inhaler towards the back of throat.
Patient does not exhale to empty the lung before the next inhalation.	Patient does not exhale to empty the lung before the next inhalation.	Patient does not exhale to empty the lung before the next inhalation.	Patient does not exhale to empty the lung before the next inhalation.
–	Patient does not turn his/her head away from the device’s mouthpiece before exhalation.	Patient exhales into the device before the next inhalation.	Patient covers the air entries while inhaling.
Patient does not seal the mouthpiece with his/her lips.	Patient did not place the mouthpiece in his/her mouth nor closed his/her lips.	Patient does not seal the mouthpiece with his/her lips.	Patient does not seal the mouthpiece with his/her lips.
NA	NA	Patient does not inhale them in sync with the drug releasing.	Patient does not inhale them in sync with the drug releasing.
Patient does not hold breath (or hold breath less than 3 s).	Patient does not hold breath (or hold breath less than 3 s).	Patient does not hold breath (or hold breath less than 3 s).	Patient does not hold breath (or hold breath less than 10 s).
Patient does not cover the lid and wait for 30–60 s for the second dose.	Patient does not dispose of the capsule and cover the lid on the device.	Patient does not exhale and wait for 30–60 s before the second puff.	Patient does not inhale twice to achieve the total daily dosage.

NA, not applicable; pMDI, pressure metered dose inhaler.