When prescribing or dispensing a pressurised metered-dose inhaler, healthcare professionals are asked to remind patients to remove the mouthpiece cover fully in preparation for inhaling a dose.
Patients should shake the inhaler to remove loose objects that may have become trapped in the inhaler during storage, and check the inside and outside of the mouthpiece are clear before inhaling.
To prevent objects entering the inhaler during storage, patients should be advised to replace the mouthpiece cover immediately after use, ensuring it clicks into place.
Since 1987, the MHRA has received 22 reports of accidental inhalation of the mouthpiece cover or objects that have become trapped in the inhaler when stored by patients. A further 36 cases have been reported outside of the UK. Objects included 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 one recent case an object became lodged in the bronchus causing granulation and had to be removed bronchoscopically.