Inhaler device handling: have we really started to address the problem?

Bosnic‐Anticevich, Sinthia

doi:10.1183/13993003.00120-2017

Cited by 17 publications

(13 citation statements)

References 38 publications

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“…Inhaled medication is the mainstay of COPD management, and therapeutic success depends on the maintenance of a correct inhalation technique. There is a growing evidence concerning inhalers misuse as a common problem worldwide 1,2. It can be associated with increased rate of severe COPD exacerbations (ECOPD),3 but the impact of inhalers misuse on COPD outcomes remains currently unknown.…”

Section: Background and Objectivesmentioning

confidence: 99%

<p>COPD: misuse of inhaler devices in clinical practice</p>

Duarte-de-Araújo¹,

Teixeira²,

Hespanhol³

et al. 2019

COPD

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Background and objectives: Inhalers mishandling remain an important clinical issue worldwide. The aim of this study was to evaluate inhalation technique in stable COPD out-patients. The variables under study were type of inhaler device (ID), patients’ preference for an inhaler, number of IDs used by each patient, beliefs about inhaler medication and some demographic, clinical and functional patients' characteristics. We aim to assess how they are related to inhalation technique. Methods: A cross-sectional study was conducted in a hospital outpatient respiratory care. COPD patients over 40 years old, diagnosed according to GOLD criteria, and using IDs were included consecutively. The Beliefs about Medicines Questionnaire (BMQ), a demographic and a clinical survey were applied. The number of IDs used by each patient and the patients’ preference for some IDs were recorded. Patients were asked to demonstrate the use of their prescribed inhalation devices, and inhaler technique was assessed by using previously defined checklists, including essential steps and critical errors. A statistics analysis was then performed. Results: We studied 300 subjects performing a total of 521 inhalation manoeuvers with 10 different IDs. At least one step incorrectly performed was found in 48.2% of demonstrations and in 29.9% critical errors were observed. Misuse was related to priming/loading in 6.9%, to inhalation manoeuver in 13.1% and to both in 10%. There was a statistically significant association between critical errors and type of ID ( P <0.001). No significant relationship was found between correct performance of key manoeuvers and patients’ preference or number of inhalers used per patient. Misuse due to critical errors was observed in 39.3% of patients and was positively related to female gender, age ≥65, lower education level and lower socioeconomic status (higher Graffar classification score), but not to patients’ clinical or functional characteristics. In the sub-group of patients presenting critical errors when using IDs, there was a statistically significant inverse association between BMQ Necessity score and number of critical errors. Conclusions: Inhalers mishandling remains disappointingly common. A good inhalation technique depends on the type of ID, and failure of inhalation manoeuver was the main cause of ID misuse. It was not associated to multiple inhalers’ use nor to patient’s preference, but to the patient’s beliefs about the necessity to use them. Elderly patients, women and those with lower education level or lower socioeconomic status demonstrate a worse inhalation technique.

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Section: Background and Objectivesmentioning

confidence: 99%

<p>COPD: misuse of inhaler devices in clinical practice</p>

Duarte-de-Araújo¹,

Teixeira²,

Hespanhol³

et al. 2019

COPD

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“…However, the misuse of inhalers has been a long-standing discussion and is still a major concern for physicians (2)(3)(4). Although decades have passed since the first inhaler was developed, the accuracy of inhaler use remains low at approximately 40% (4,5). Poor inhaler technique is associated with poor disease control and frequent disease exacerbation (5,6).…”

Section: Introductionmentioning

confidence: 99%

Comparing Inhaler Use Technique Based on Inhaler Type in Elderly Patients with Respiratory Disease

Lee¹,

Song

Won

et al. 2021

Tuberc Respir Dis

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Background We aimed to investigate inhaler device handling in elderly patients. Furthermore, we compared inhaler devices with respect to misuse and error correction. Methods Inhaler use technique was assessed using standardized checklists at the first and 3-months follow-up visits after retraining. The primary outcome was differences in the acceptable use ratio among inhaler devices. Secondary outcomes included differences in error correction, most common step of misuse, and factors affecting the accuracy of inhaler use. Results A total of 251 patients (mean age, 76.4) were included and the handling of 320 devices was assessed in the study. All patients had been trained before, but only 24.7% of them used inhalers correctly.

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“…6 Hence, fast inhalation reduces the efficacy of the pMDI and results in poor disease control. [7][8][9] Optimal lung deposition of the emitted drug is achieved at an inspiratory flow through the pMDI of 30 -60 L/min; however, basic verbal counseling cannot ensure that the patient inspiratory flow through the pMDI is within this range. 3,4 Counseling conducted on a regular basis enhances therapy outcomes and improves the control of obstructive lung diseases.…”

Section: Introductionmentioning

confidence: 99%

Impact of Advanced Patient Counseling Using a Training Device and Smartphone Application on Asthma Control

et al. 2019

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BACKGROUND: Pressurized metered-dose inhalers (pMDIs) are among the most commonly used aerosol delivery devices. Poor lung deposition from a pMDI is often a result of incorrect inhalation technique. The aim of this study was to compare the impact of combining a newly released training device with a smartphone application (advanced counseling) in asthma control to the impact of traditional verbal training. METHODS: A total of 371 subjects with asthma were divided into 2 groups: advanced counseling (n ‫؍‬ 187) and verbal counseling (n ‫؍‬ 184). Both groups had 3 visits, each meeting being a month apart. At each visit, lung function (ie, FEV 1 , ratio of FEV 1 to forced vital capacity [FEV 1 /FVC], and peak expiratory flow) were measured, an asthma control test was given, and subjects were trained in the correct inhalation technique. Inhalation flow through the pMDI was also recorded at each visit because the correct pMDI technique requires an inspiratory flow of < 60 L/min. RESULTS: In the advanced counseling group, lung function significantly improved after both the first and the second visit (P < .001), whereas in the verbal group, lung function improved significantly only after the second visit (P < .001). Although the inspiratory flow through the pMDI improved significantly in both groups, it was closest to the target range in the advanced counseling group. In addition, more subjects in the advanced counseling group had monthly increases of > 3 points in their asthma control test scores compared to the verbal counseling group. CONCLUSIONS: The use of a training device with a smartphone application in conjunction with traditional verbal counseling in pMDI technique resulted in significant improvements in asthma control compared to traditional verbal counseling in pMDI technique alone.

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Inhaler device handling: have we really started to address the problem?

Cited by 17 publications

References 38 publications

<p>COPD: misuse of inhaler devices in clinical practice</p>

<p>COPD: misuse of inhaler devices in clinical practice</p>

Comparing Inhaler Use Technique Based on Inhaler Type in Elderly Patients with Respiratory Disease

Impact of Advanced Patient Counseling Using a Training Device and Smartphone Application on Asthma Control

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