Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care

Lindh, Annika; Theander, Kersti; Arne, Mats; Lisspers, Karin; Lundh, Lena; Sandelowsky, Hanna; Ställberg, Björn; Westerdahl, Elisabeth; Zakrisson, Ann‐Britt

doi:10.1002/nop2.357

Cited by 20 publications

(23 citation statements)

References 31 publications

(49 reference statements)

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“…Due to these differences, the inhaler device model or models should be chosen to suit each patient’s circumstances and abilities 4 , 9 . However, errors in inhaler technique remain a large problem in COPD care 10 , 11 .…”

Section: Introductionmentioning

confidence: 99%

Critical inhaler technique errors in Swedish patients with COPD: a cross-sectional study analysing video-recorded demonstrations

Sulku

Bröms

Högman

et al. 2021

npj Prim. Care Respir. Med.

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A correct use of inhaler devices is essential in chronic obstructive pulmonary disease (COPD) treatment. Critical errors were studied by analysing 659 video-recorded demonstrations of inhaler technique from 364 COPD patients using six different inhaler device models. The majority of the included patients used two (55%) or more (20%) device models. Overall, 66% of the patients made ≥1 critical error with at least one device model. The corresponding numbers for patients using 1, 2 and ≥3 device models were 43%, 70% and 86%, respectively. The only factor associated with making ≥1 critical error was simultaneous use of two (adjusted odds ratios (aOR) 3.17, 95% confidence interval (95% CI) 1.81, 5.64) or three or more (aOR 8.97, 95% CI 3.93, 22.1) device models. In conclusion, the proportion of patients making critical errors in inhaler technique was substantial, particularly in those using several different device models. To obtain optimal COPD treatment, it is important to assess a patient’s inhaler technique and to minimise the number of inhaler device models.

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Section: Introductionmentioning

confidence: 99%

Critical inhaler technique errors in Swedish patients with COPD: a cross-sectional study analysing video-recorded demonstrations

Sulku

Bröms

Högman

et al. 2021

npj Prim. Care Respir. Med.

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“…37,38 Up to 45% of patients make at least one error, including 50% related to devices and 31% related to inhalation technique, while 19% make errors related both to devices and to inhalation technique. 39 Indeed, one study found that in patients using multi-dose DPIs, 46% demonstrated at least one 36 Since inhalers are key to the management of daily symptoms, chronic disease and acute emergencies, the choice of inhaler device and inhaler technique teaching has a major impact on patient outcomes. 40 Making at least one critical error due to device switch can lead to increased health-care expenditure related to the need for additional health-care visits and pharmacological treatment.…”

Section: Discussionmentioning

confidence: 99%

Health-care Resource Requirements and Potential Financial Consequences of an Environmentally Driven Switch in Respiratory Inhaler Use in England

Attar-Zadeh

Lewis

Orlović

2021

JHEOR

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Background: To reduce greenhouse gas emissions, national initiatives advocate the phasing down of respiratory inhalers that use a fluorinated gas as a propellant (pressurised metered-dose inhalers [pMDI]). Nevertheless, pMDIs continue to be an effective and common choice. Objective: To assess the potential financial impact of patients with asthma or chronic obstructive pulmonary disease (COPD) switching from pMDIs to dry powder inhalers (DPIs) in a representative primary care network (PCN) population of 50 000 and the English National Health Service (NHS). Methods: Epidemiological data were combined with current inhaler use patterns to estimate the resources and costs associated with this transition, varying patient acceptance scenarios. Results: Depending on the approach, resource requirements ranged from £18 000 – £53 000 for a PCN, and from £21 – £60 million for the English NHS. Discussion: Significant funds are needed to successfully manage targeted inhaler transitions, together with counselling and follow-up appointment with an appropriately skilled clinician to assess the patient’s inhaler technique and ensure disease control. Conclusions: Targeted transition of inhalers must achieve a balance between environmental impacts, organisational factors, and patient requirements. The resources for managing a switch can be substantial but are necessary to appropriately counsel and support patients, whilst protecting the environment.

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“…According to the research of Lindh et al, most of the mistakes made by patients are associated with the type of the device used and an incorrect inhalation technique. The main problems were the lack of slow, deep exhalation before the start of inhalation, and an insu cient breath-hold time after drug application [23,24,25]. Based on the conducted study, it was shown that the trained pharmacists were able to conduct a more detailed consultation than untrained ones.…”

Section: Discussionmentioning

confidence: 99%

The Influence of the Pharmacists’ Training on the Patients’ Education in the Field of Inhalation Techniques in Community Pharmacies in Poland

Waszyk-Nowaczyk

Targosz

Guzenda

et al. 2021

Preprint

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Background: Following the example of other countries, it is very important to educate patients on the correct use of inhalers by properly trained healthcare professionals, including pharmacists.Objectives: The aim of the study was to assess the quality and comprehensiveness of professional advice given by pharmacists on the use of inhalers, which was determined by the pharmacists’ level of training. Methods: The study was conducted from June 2019 to March 2020. 150 pharmacists from Poznan and Warsaw (Poland) were involved. Before the study began, the professional education of 240 pharmacists was conducted in Warsaw to implement standard operating procedures. The study used the model of a mystery patient.Results: The conversation with a trained pharmacist lasted on average 5.5 minutes, with an untrained one - 3.0 minutes. Placebo inhalers were used more often by trained pharmacists during patients’ education. 10.3% of untrained pharmacists did not provide any education. Additionally, untrained employees quality of advice were assessed on an average of 3.5 points, while trained ones - 7.6 points. Conclusions: This study has shown that there is a need for professional training among pharmacists in Poland, which translates into better patient education in the field of inhalation techniques.

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Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care

Cited by 20 publications

References 31 publications

Critical inhaler technique errors in Swedish patients with COPD: a cross-sectional study analysing video-recorded demonstrations

Critical inhaler technique errors in Swedish patients with COPD: a cross-sectional study analysing video-recorded demonstrations

Health-care Resource Requirements and Potential Financial Consequences of an Environmentally Driven Switch in Respiratory Inhaler Use in England

The Influence of the Pharmacists’ Training on the Patients’ Education in the Field of Inhalation Techniques in Community Pharmacies in Poland

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