How many instructions are required to correct inhalation errors in patients with asthma and chronic obstructive pulmonary disease?

Takaku, Yotaro; Kurashima, Kazuyoshi; Ohta, Chie; Ishiguro, Takashi; Kagiyama, Naho; Yanagisawa, Tsutomu; Takayanagi, Noboru

doi:10.1016/j.rmed.2016.12.012

Cited by 85 publications

(112 citation statements)

References 20 publications

(10 reference statements)

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“…Our study confirmed that both new and continuous users of inhalers require attention. In addition, one study suggests that it takes at least three educational sessions by a trained pharmacist to correct inhalation errors [35]. A systematic review of the effectiveness of inhaler technique interventions concluded that the effect decreases over time, which signals the need for periodic reinforcement strategies [36].…”

Section: Discussionmentioning

confidence: 99%

Checking Inhaler Technique in the Community Pharmacy: Predictors of Critical Errors

et al. 2020

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Inhaled medications are critical in the pharmaceutical management of respiratory conditions, however, the majority of patients demonstrate at least one critical error when using an inhaler. Since community pharmacists can be instrumental in addressing this care gap, we aimed to determine the rate and type of critical inhaler errors in community pharmacy settings, elucidate the factors contributing to inhaler technique errors, and identify instances when community pharmacists check proper inhaler use. Fourth year pharmacy students on community practice placement (n = 53) identified 200 patients where at least one error was observed in 78% of participants when demonstrating inhaler technique. Prevalent errors of the users were associated with metered dose inhaler (MDI) (55.6%), Ellipta® (88.3%), and Discus® (86.7%) devices. Overall, the mean number of errors was 1.09. Possession of more than one inhaler, use of rescue inhaler, and poor control of asthma were found to be significant predictors of having at least one critical error. In all participating pharmacies, inhaler technique is mainly checked on patient request (93.0%) and for all new inhalers (79.0%).

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Section: Discussionmentioning

confidence: 99%

Checking Inhaler Technique in the Community Pharmacy: Predictors of Critical Errors

et al. 2020

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“…Among these articles, 33 did not provide information on device use errors, resulting in a total of 12 publications that were included in this meta-analysis. 22,[39][40][41][42][43][44][45][46][47][48][49] Since this study involved reviewing aggregate level secondary data published in publicly available studies and there was no access to primary patient-level data, protocol approval by the Institutional Review Board and Ethical Committee was waived.…”

Section: Search Strategymentioning

confidence: 99%

“…Significant heterogeneity was observed across the 12 studies included in our meta-analysis (I 2 ¼ 92.8%; test for heterogeneity: Q(df ¼ 11): 273.6, p < 0.001). Sensitivity analysis revealed that the pooled effect size was altered with the removal of five studies 22,39,41,44,49 (Figure 4). The resulting overall effect size was 57.5% (95% CI: 21.2-93.9) across the five studies relative to 59.8% (95% CI: 51.3-68.4) for the remaining seven studies.…”

Section: Heterogeneity and Sensitivity Analysismentioning

confidence: 99%

Device use errors with soft mist inhalers: A global systematic literature review and meta-analysis

et al. 2020

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Inhaled bronchodilators are the cornerstone of treatment for chronic obstructive pulmonary disease (COPD). Soft mist inhalers (SMIs) are devices that deliver bronchodilators. Although correct device use is paramount to successful medication delivery, patient errors are common. This global systematic literature review and meta-analysis examined device use errors with SMIs among patients with obstructive lung diseases. PubMed, EMBASE, PsycINFO, Cochrane, and Google Scholar were searched to identify studies published between 2010 and 2019 that met the following inclusion criteria: (a) English language; (b) a diagnosis of COPD, bronchitis, or emphysema; and (c) reported device use errors among adults receiving long-acting bronchodilator treatment with Respimat® SMI (i.e. Spiriva®, Stiolto®, Spiolto®, and Striverdi®). Descriptive statistics examined sociodemographics, clinical characteristics, and device use errors. Meta-analysis techniques were employed with random-effects models to generate pooled mean effect sizes and 95% confidence intervals (CIs) for overall and step-by-step errors. The I 2 statistic measured heterogeneity. Twelve studies ( n = 1288 patients) were included in this meta-analysis. Eighty-eight percent of patients had COPD, and most had moderate/very severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease spirometric stages II to IV). Aggregate results revealed that 58.9% (95% CI: 42.4–75.5; I 2 = 92.8%) of patients made ≥1 device use errors. Among 11 studies with step-by-step data, the most common errors were failure to (1) exhale completely and away from the device (47.8% (95% CI: 33.6–62.0)); (2) hold breath for up to 10 seconds (30.6% (95% CI: 17.5–43.7)); (3) take a slow, deep breath while pressing the dose release button (27.9% (95% CI: 14.5–41.2)); (4) hold the inhaler upright (22.6% (95% CI: 6.2–39.0)); and (5) turn the base toward the arrows until it clicked (17.6% (95% CI: 3.0–32.2)). Device use errors occurred in about 6 of 10 patients who used SMIs. An individualized approach to inhalation device selection and ongoing training and monitoring of device use are important in optimizing bronchodilator treatment.

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“…It has been shown that most inhaler users not only make errors but also those patients who did not get proper education on inhaler technique are more inclined to misuse their device [82]. A recent Japanese study has also suggested that patients, regardless of having asthma or COPD, require to be instructed at least three times, i.e., given demonstrations by trained personnel in order to limit inhaler handling errors [83]. Notably, while about 65% of patients made at least one handling error that could affect the efficacy after an initial guidance on how to use the Breezhaler Ò , the Ellipta Ò or Respimat Ò , more than 90% of patients using any device could successfully learn the correct use after receiving guidance from pharmacists three times successively [83].…”

Section: Handling Of Inhaler Devicesmentioning

confidence: 99%

“…A recent Japanese study has also suggested that patients, regardless of having asthma or COPD, require to be instructed at least three times, i.e., given demonstrations by trained personnel in order to limit inhaler handling errors [83]. Notably, while about 65% of patients made at least one handling error that could affect the efficacy after an initial guidance on how to use the Breezhaler Ò , the Ellipta Ò or Respimat Ò , more than 90% of patients using any device could successfully learn the correct use after receiving guidance from pharmacists three times successively [83]. Whether inhaler handling errors remain frequent among longterm inhaler users or are associated with worse clinical outcomes in COPD is discussed below.…”

Section: Handling Of Inhaler Devicesmentioning

confidence: 99%

Inhaler Devices for Delivery of LABA/LAMA Fixed-Dose Combinations in Patients with COPD

et al. 2019

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Inhaled fixed-dose combinations (FDCs) of a long-acting b-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) have become the cornerstone for the maintenance treatment of symptomatic COPD patients. In this regard, global COPD treatment guidelines have recognized the importance of inhaler devices as integral contributors to the effectiveness of LABA/ LAMA FDCs and recommend regular assessment of inhaler device use by the patients in order to improve long-term clinical outcomes. Optimal disease control is also highly dependent upon patient preferences and adherence to inhaler devices. This review objectively examines and compares the major inhaler devices used to deliver different LABA/LAMA FDCs, discusses the inhaler device characteristics that determine drug deposition in the airways, real-life preference for inhaler devices, and handling of inhaler devices that impact the results of the long-term management of COPD. The introduction of new LABA/LAMA FDCs, new inhaler devices, and more clinical studies have created confusion among physicians in choosing the optimal inhaled therapy for COPD patients; in this context, this review attempts to provide an evidencebased framework for informed decision-making with a particular focus on the inhaler devices. Enhanced digital features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.7776272.

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How many instructions are required to correct inhalation errors in patients with asthma and chronic obstructive pulmonary disease?

Cited by 85 publications

References 20 publications

Checking Inhaler Technique in the Community Pharmacy: Predictors of Critical Errors

Checking Inhaler Technique in the Community Pharmacy: Predictors of Critical Errors

Device use errors with soft mist inhalers: A global systematic literature review and meta-analysis

Inhaler Devices for Delivery of LABA/LAMA Fixed-Dose Combinations in Patients with COPD

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