Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients

Abstract

Acute exacerbations of chronic obstructive pulmonary disease (COPD) can be prevented by inhaled treatment. Errors in inhaler handling, not taken into account in clinical trials, could impact drug delivery and minimise treatment benefit. We aimed to assess real-life inhaler device handling in COPD patients and its association with COPD exacerbations.To this end, 212 general practitioners and 50 pulmonologists assessed the handling of 3393 devices used for continuous treatment of COPD in 2935 patients. Handling errors were observed in over 50% of handlings, regardless of the device used. Critical errors compromising drug delivery were respectively made in 15.4%, 21.2%, 29.3%, 43.8%, 46.9% and 32.1% of inhalation assessment tests with Breezhaler® (n=876), Diskus® (n=452), Handihaler® (n=598), pressurised metered-dose inhaler (pMDI) (n=422), Respimat® (n=625) and Turbuhaler® (n=420).The proportion of patients requiring hospitalisation or emergency room visits in the past 3 months for severe COPD exacerbation was 3.3% (95% CI 2.0-4.5) in the absence of error and 6.9% (95% CI 5.3-8.5) in the presence of critical error (OR 1.86, 95% CI 1.14-3.04, p<0.05).Handling errors of inhaler devices are underestimated in real life and are associated with an increased rate of severe COPD exacerbation. Training in inhaler use is an integral part of COPD management.

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

“…Finally, as our questionnaire assessed actual treatment and not just prescription, adherence to treatment could influence the proportion of patients with maintenance treatment. Yet, adherence and correct inhaler technique have been reported to be equal between sexes [32] or even better in men [33,34] and subsequently should not explain our results. In summary, more research in sex differences and its implications for therapy is obviously needed [35,36].…”

Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD

“…Targeting inhaled drug formulations to the peripheral airways is not efficient, with most of the formulations being deposited in the central airways. Reducing the mean particle size of the inhaled drug increases the fraction reaching the peripheral areas of the lung [111]. Meta-analysis of RCTs demonstrated that extra-fine ICS have significantly higher odds of achieving asthma control with lower exacerbation rates at significantly lower doses than fine-particle ICS [120].…”

Comparison of correct technique and preference for Spiromax®, Easyhaler® and Turbuhaler®: a single-site, single-visit, crossover study in inhaler-naïve adult volunteers

“…To our knowledge, the drop in delivered dose resulting from actuation of Turbuhaler or Easyhaler in a non-upright manner has not been reported, with the exception of one study that described an 8% drop resulting from horizontal actuation of the Turbuhaler [16]. However, reports of several studies of inhaler technique have underscored the importance of holding the Turbuhaler upright [6, 7, 11, 17–20]…”

“…Many patients in routine clinical practice do not use their inhalers correctly. This may be due to a lack of training or inappropriate device choice, and poor inhaler technique correlates with both poor control of symptoms and increased exacerbations [5–7]. In addition, approximately 50% of adults and children do not take their medications as prescribed [5].…”