Like many young children my daughter frequently needs her spacer inhaler during the night as her symptoms are often exacerbated during the early hours - but administering it without putting the light on and waking up the whole household is not an easy matter.

An asthma spacer is an add-on device that makes it easier to administer a metered dose of aerosolized medication. The spacer is a tube or ‘chamber’ between the canister of medication and the patient’s mouth, allowing the patient to inhale the medication by breathing in slowly and deeply.

Because toddlers and young children find it difficult to coordinate inhaling through the mouth and exhaling through the nose, the front part of this chamber is closed off by a facemask that covers both their mouth and nose. It has valves to ensure that the dose of medication suspended in the chamber is inhaled and that the exhaled breath exits through the exhalation valve.

So, could I actually ‘do it’ the dark? Possibly. But will I? Probably not. But why not? It should be a ‘no-brainer’ but it’s practically impossible! The number of steps involved in assembly make it ‘fiddly’, the preciseness required in fitting it to a wriggling child make it ‘tricky’, and the fact that the only indication of success is to listen to the valve clicking (generally on top of a crying child!) means that there is virtually no guarantee of the child receiving the required dose as there’s so much room for error.

What is it that will make a medical device so intuitive that we can use it under any circumstances and at any time? How often do we (even as educated professionals) fail to medicate appropriately because of inconvenience, technical difficulty, social embarrassment or environment. Let’s face it - even when we have to simply take a drug three times a day at home, we never take it at 8 hourly intervals, even though we know in terms of efficacy that that is the optimum dosing regimen… We take the tablets at 8:00am, 4:00pm and just before bed. Even worse with your children as they go to bed earlier so we medicate them in their waking hours. That’s bad enough when it’s a course of antibiotics, but when we are dealing with life-long debilitating conditions we really should do better.

As design professionals we consider at great length the technical task to be completed effectively. We combine this with the end-user in mind, but we don’t always take into consideration the potential variety of environments or scenarios in which a device might need be used.

Imagine if a young person could administer his insulin at the cinema without being noticed; if an older person with decreased dexterity could self-administer his or her drugs in at home without a carer being present. Or think how much easier it would be all round if I could give my little girl her inhaler in the dark.

Dark, light, at the cinema, at home... if we want to give patients the best chance of optimum disease management, morbidity and ultimately mortality we must consider all aspects of device usability. This extends beyond the mechanics and the technicality of the device and must embrace environment, emotion and interaction. Our behaviours are shaped by all these factors and the impact can be substantial.

We should be considering these aspects and encompassing these scenarios in the functionality of our outcomes to enhance the patient journey - and maybe facilitate a decent night's sleep into the bargain!

So the question is: Can an inhaler be designed for use without ‘fiddling’ in the dark? And if not, why not?

Contact: Adele Graham-King, New Business Development, Smallfry

+44 (0)24 7654 5678, [email protected], www.smallfry.com

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