Qualitative analysis of microbial contamination of inhalers

Inhalation is the principal drug delivery route for treatment of respiratory conditions including asthma and chronic obstructive pulmonary disease, with a quick onset of action and reduced adverse effects being the major advantages over systemic drug delivery.1 Placebo inhaler devices are used to teach inhaler technique by allowing patients to gain experience of how inhalers operate and healthcare professionals to assess technique. Placebo inhaler devices are labelled as ‘single use’ items and are recommended as ‘individual use’ in patient information leaflets, although re-use of these devices has been advocated.2 M. Richardson, S. Wyllie, A. Dennis and C. Fehrenbach, Reducing the risk: the use of placebo respiratory equipment in clinical practice, J Infect Prev 10 (2009), pp. 14–20. View Record in Scopus | Cited By in Scopus (1)2 Re-use of inhaler devices may lead to contamination and cross-contamination.[3] and [4] Standard cleaning procedures for placebo devices are elusive. For medicine-containing inhalers, patient information leaflets recommend weekly cleaning with a dry cloth, to prevent the inhaler from blocking but not for microbial disinfection. It is questioned whether more efficacious cleaning procedures are needed. Little research has been conducted on the cleaning procedures of inhalers at present. Contamination of respiratory devices other than inhalers has been well documented with up to 30% of spacers and 65% of nebulisers contaminated.[5], [6] and [7] The contaminants were predominantly Bacillus spp. and Pseudomonas spp.. There is little research into the contamination of placebo devices.