Lack of awareness of need to clean CFC-free metered-dose inhalers

J Asthma. 2004;41(3):367-73. doi: 10.1081/jas-120026096.


Background: Chlorofluorocarbon (CFC)-free metered-dose inhalers (MDIs) were introduced into Australia in 1999. Device care instructions were modified (e.g., CFC-free salbutamol inhalers to be washed weekly), but this information was not communicated directly to health care professionals.

Objective: This pilot study aimed to assess the level of awareness of device care protocols for CFC-free MDIs by patients and their pharmacists.

Setting and design: Purchasers of CFC-free MDIs were recruited from four community pharmacies. They were interviewed regarding information sources, knowledge of propellant change, and awareness of and adherence to device care protocols. The dispensing pharmacists were interviewed for knowledge of CFC-free device care. The primary outcome variable was awareness of the relevant device care protocol.

Results: Thirty-nine patients were interviewed. Most patients (77%) were aware of the change to CFC-free propellant. Only nine patients (23%) were aware of the need to wash the device holder, and four patients (10% of total) complied with the specified protocol. One of the ten dispensing pharmacists could describe correct device care protocols for the CFC-free MDIs.

Conclusions: Although most patients are aware that MDIs are now CFC-free, there is a low level of awareness of the device care required for these inhalers, and a very low rate of compliance with recommended practice. Although the clinical impact of failing to wash the device holder is unclear, this added instruction may have substantial implications for patient satisfaction and medication delivery. Pharmaceutical manufacturers need to highlight to health care professionals any clinically important changes in device care instructions, so that appropriate information may be passed on to patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia
  • Awareness
  • Chlorofluorocarbons
  • Clinical Competence / standards
  • Decontamination / methods*
  • Equipment Contamination*
  • Humans
  • Metered Dose Inhalers / microbiology*
  • Patient Compliance*
  • Pharmacy / standards*
  • Pilot Projects


  • Chlorofluorocarbons