Patients at risk of accidental inhalation of objects from their inhalers

Patients may accidentally inhale the mouthpiece of a pressurised metered dose inhaler (pMDI) or objects that have become trapped inside the device if it is not used or stored correctly, the medicines regulator has warned.

The alert, by the Medicines and Healthcare products Regulatory Agency (MHRA) follows 22 Yellow Card reports of this happening. There have been reports of a further 36 cases outside of the UK.

The reports include patients who have inhaled objects into the back of the throat, resulting in coughing. In some cases, objects were aspirated, causing airway obstruction.

Loose/foreign objects reported in these cases include tissues, stickers, coins, and plastic items. Some incidents resulted in pharyngeal injury, temporary asphyxiation, or surgical removal of aspirated objects. One patient experienced a pneumothorax.

In a recent report a foreign body was aspirated, became lodged in the patient’s bronchus causing granulation and had to be removed bronchoscopically.

Healthcare professionals are advised to:

• Train patients in the correct use of their inhaler; instructions for patients are provided in the patient information leaflet
• Tell patients to remove the mouthpiece cover fully, shake the inhaler to remove loose objects that may not be visible, and check the inside and outside of the mouthpiece are clear before inhaling a dose
• To prevent objects entering the mouthpiece during storage, remind patients to replace the cover immediately after use, ensuring it clicks into place
• Pharmacists dispensing a pMDI should emphasise to patients the need to clean the device regularly by following the instructions in the patient leaflet and to inspect the device for signs of damage; devices that are damaged should be replaced immediately
• Report adverse incidents during use of inhalers on a Yellow Card.

You can refresh your inhaler training skills at a hands-on workshop run in conjunction with Education for Health at the PCRS-UK conference Building Confidence in a Changing World. 28-29 September, The International Centre, Telford. More information | Rates | Programme | Venue | Register