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A recent University of Texas study suggested that new and improved ways of training patients on how to use epinephrine autoinjectors and devices to treat asthma are needed after finding that most patients continue to use both types of devices incorrectly.


Epinephrine autoinjectors deliver adrenaline to reverse the effects of anaphylaxis, a severe allergic reaction. Asthma metered-dose inhalers (MDIs) deliver various medicines and are used in conjunction with spacers, which deliver the medicine more effectively to the lungs.


While previous studies have found that the devices are often used incorrectly, this study sought to identify the factors associated with incorrect use. The results were published in a January issue of Annals of Allergy, Asthma & Immunology.


A total of 102 patients using epinephrine and 44 patients using MDIs with spacers were enrolled from adult and pediatric asthma clinics. Most patients were female.


Only 16% of patients with epinephrine autoinjectors could use the device properly. Of those who did not, over half of them (56%) missed three or more steps. The most common mistake was not holding the autoinjector in long enough (10 seconds), as well as failing to put the needle end on the outside of the thigh and failing to depress the autoinjector hard enough to release the needle.


Alarmingly, the researchers found that the mistakes made by those attempting to self-inject epinephrine would have resulted in them not receiving any treatment at all during an anaphylactic episode.




Of asthma patients, only 7% could use their devices perfectly. The majority (63%) missed 3 or more steps, including not exhaling before taking a dose. Other mistakes included not realizing that a sound on the spacer meant that they were breathing in the dose too fast, and not shaking the inhaler before administering the second puff. The researchers said these mistakes would have resulted in a lesser amount of the drug being delivered, and not the full amount.


Men were more likely to demonstrate proper use of the devices, as were younger patients and those with medical training, such as nursing school, medical school, or EMT training. White race was also linked to a higher rate of correct use of the devices.


The researchers recommended repeated verbal instruction and visual demonstrations of the devices.


Here are training videos showing how to use these devices:


Asthma metered-dose inhalers with spacer:


How to use an EpiPenβ„’:


How to use Auvi-Qβ„’:


How to use a generic epinephrine autoinjector:






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Kids With Food Allergies
A Division of the Asthma and Allergy Foundation of America
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