Inhalation Devices and Patient Interface: Human Factors

Leiner, Stefan; Parkins, David A.; Lastow, Orest

doi:10.1208/s12248-015-9717-9

Cited by 11 publications

(8 citation statements)

References 10 publications

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“…Finally perhaps there is room for improved technology, perhaps with new inhalers with smaller particle size, and simpler use and design which could make the airway delivery of medicinals by inhaler devices more reliable and less operator dependent [ 5 , 28 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of correct technique in patients using pressurized metered dose inhalers

et al. 2017

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BackgroundCorret inhaler technique is recommended by guidelines for optimum asthma care. The objective of the study is to determine real life predictors of correct pressurized metered dose inhaler (pMDI) technique in Asthma and COPD patients.MethodsTwo hundred eight adult patients aged 18+ from respiratory outpatients (69.2%) and the community on regular pMDI for a diagnosis of Asthma (78.9%) or COPD, were recruited. A questionnaire containing 31 possible predictors was administered and pMDI technique with or without spacer was observed by trained researchers on 12 point steps, of which 4 were considered critical.Results23.1% of patients had no errors in inhaler technique and 32.2% had no critical errors. Patients had a median of 10 correct steps (IQR9-11), and 3(IQR2-4) correct critical steps. Using binary logistic regression the predictors of 10 correct steps were, other healthcare professional (pharmacist, nurse, physiotherapist) explained OR 3.73(1.63–8.54, p = 0.001), male gender 2.70(1.35–5.39, p = 0.004), self-score 1–10 1.21(1.05–1.39, p = 0.007), spacer use 0.38(0.19–0.79, p = 0.007), inhaled steroid 3.71(1.34–10.25, p = 0.01), heart disease 0.31(0.13–0.77, p = 0.01), pneumococcal vaccine 2.48(1.0–6.15, p = 0.043), education level 1–4 1.44(1.00–2.06, p = 0.05) and respiratory physician explained 0–7 times, 1.11(0.99–1.26, p = 0.08). Using ordinal logistic regression, predictors for correct critical steps 0–4, were: technique self-score 1–10 1.2(1.05–1.42, p = 0.006), inhaled corticosteroid use 2.78(1.1–7.31, p = 0.03) and education level 1–4 1.41(1.02–1.95, p = 0.03 Times respiratory physician explained inhaler technique 0–7 1.1(0.98–1.24, p = 0.1), married status 1.55(0.85–2.82, p = 0.15), hypercholesterolaemia 0.52(0.25–1.01, p = 0.054) and male gender 1.76(0.97–3.18, p = 0.06).ConclusionsKnown predictors of correct pMDI use, such as gender and education level were confirmed, while age and concomitant use of dry powder inhaler were not. Pneumococcal vaccination and awareness of steroid side effects were possible novel positive predictors, while the use of a spacer and co-morbidity with heart disease were found to be negative predictors. Patients’ self-assessment correlated well with actual performance. This information may be useful in defining approaches to optimize inhaler techniques which are so susceptible to human error.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0386-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Predictors of correct technique in patients using pressurized metered dose inhalers

et al. 2017

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“…As changes of devices may decrease adherence, it would be useful to measure upfront which inhaler is best suited for a given patient. (32,38,39) This is further emphasized by the measurements performed in healthy volunteers, where the correlation of inhalation parameters was less optimal, especially using inhalers where actuation of device and inhalation needs coordination.…”

Section: Discussionmentioning

confidence: 99%

The Repeatability of Inspiration Performance Through Different Inhalers in Patients with Chronic Obstructive Pulmonary Disease and Control Volunteers

Erdélyi

Lázár

Odler

et al. 2020

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Background: Inhalation therapy is a cornerstone of treating patients with chronic obstructive pulmonary disease (COPD). Inhaler types and through-device inhalation parameters influence airway drug delivery. We aimed to measure the repeatability of inhalation performance through four different commercially available inhalers. Methods: We recruited control subjects (n ¼ 22) and patients with stable COPD (S-COPD, n ¼ 16) and during an acute exacerbation (AE-COPD, n ¼ 15). Standard spirometry was followed by through-device inhalation maneuvers using Ellipta Ò , Evohaler Ò , Respimat Ò , and Genuair Ò. Through-device inspiratory vital capacity (IVC d) and peak inspiratory flow (PIF d), as well as inhalation time (t in) and breath hold time (t bh), were recorded and all measurements were repeated in a random manner. Results: There was no difference in forced expiratory volume in 1 second (FEV 1) between patients (S-COPD: 39-5 vs. AE-COPD: 32%-5% predicted, p > 0.05). In controls, the IVC d was significantly reduced by all four devices in comparison with the slight reduction seen in COPD patients. In all subjects, PIF was lowered when inhaling through the devices in order of decreasing magnitude in PIF d : Evohaler, Respimat, Ellipta, and Genuair. The Bland-Altman analysis showed a highly variable coefficient of repeatability for IVC d and PIF d through the different inhalers for all COPD patients. Based on the intermeasurement differences in patients, Respimat and Genuair showed the highest repeatability for IVC d , while Genuair and Ellipta performed superior with regard to PIF d. Conclusions: Our study is the first to compare repeatability of inhalation performances through different inhalers in COPD patients, showing great individual differences for parameters influencing lung deposition of inhaled medication from a given device. Our data provide new insight into the characterization of inhaler use by patients with COPD, and might aid the selection of the most appropriate devices to ensure the adequate and consistent delivery of inhaled drugs.

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“…Unfortunately, approximately 22–78% of patients with asthma and COPD and 31–53% of CF patients are poorly adherent to their inhaled medications [ 36 , 37 ]. Errors in inhalation techniques occur in a percentage of 6.8–43.2%, and only 10–52% of physicians are adequately informed regarding proper device use [ 38 , 39 ]. The most common clinically significant errors include incorrect positioning of both the device and the head, failure (i) to insert and pierce the capsule (for the capsule-based DPIs), (ii) to exhale away from the device prior to inhalation, (iii) to hold the breath after inhalation, and (iv) to maintain a forceful and deep inspiration.…”

Section: Limitations Of Currently Available Dpismentioning

confidence: 99%

Dry Powder Inhalers in the Digitalization Era: Current Status and Future Perspectives

et al. 2021

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During the last decades, the term “drug delivery systems” (DDSs) has almost fully replaced previously used terms, such as “dosage forms”, in an attempt to emphasize the importance of the drug carrier in ensuring the claimed safety and effectiveness of the product. However, particularly in the case of delivery devices, the term “system”, which by definition implies a profound knowledge of each single part and their interactions, is not always fully justified when using the DDS term. Within this context, dry powder inhalers (DPIs), as systems to deliver drugs via inhalation to the lungs, require a deep understanding of the complex formulation–device–patient interplay. As of now and despite the progress made in particle engineering and devices design, DPIs’ clinical performance is limited by variable patients’ breathing patterns. To circumvent this pitfall, next-generation DPIs should ideally adapt to the different respiratory capacity of individuals across age, health conditions, and other related factors. In this context, the recent wave of digitalization in the health care and industrial sectors may drive DPI technology towards addressing a personalized device–formulation–patient liaison. In this review, evolving technologies are explored and analyzed to outline the progress made as well as the gaps to fill to align novel DPIs technologies with the systems theory approach.

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Inhalation Devices and Patient Interface: Human Factors

Cited by 11 publications

References 10 publications

Predictors of correct technique in patients using pressurized metered dose inhalers

Predictors of correct technique in patients using pressurized metered dose inhalers

The Repeatability of Inspiration Performance Through Different Inhalers in Patients with Chronic Obstructive Pulmonary Disease and Control Volunteers

Dry Powder Inhalers in the Digitalization Era: Current Status and Future Perspectives

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