Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes

Price, David; Román-Rodríguez, Miguel; McQueen, R. Brett; Bosnic‐Anticevich, Sinthia; Carter, Victoria; Gruffydd-Jones, Kevin; Haughney, John; Henrichsen, Svein Høegh; Hutton, Catherine; Infantino, Antonio; Lavorini, Federico; Law, Lisa M; Lisspers, Karin; Papi, Alberto; Ryan, Dermot; Ställberg, Björn; Molen, Thys van der; Chrystyn, Henry

doi:10.1016/j.jaip.2017.01.004

Cited by 243 publications

(304 citation statements)

References 34 publications

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“…Self-reported intranasal corticosteroid (INCS) and oral antihistamine use for the treatment of rhinitis were recorded. Inhaler technique was assessed, and the number and type of error were recorded for each inhaler device against predefined checklists developed by a steering committee of experts in the field [36]. This technique was assessed by the pharmacist, who had received training in the identification of inhaler technique errors.…”

Section: Asthma Reviewmentioning

confidence: 99%

Lack of asthma and rhinitis control in general practitioner-managed patients prescribed fixed-dose combination therapy in Australia

Bosnic‐Anticevich

Kritikos

Carter³

et al. 2017

Journal of Asthma

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Objectives:The first aim of the study (i) assess the current asthma status of general-practitionermanaged patients receiving regular fixed-dose combination inhaled corticosteroid and long-acting beta 2 agonist (FDC ICS/LABA) therapy and (ii) explore patients' perceptions of asthma control and attitudes/behaviors regarding preventer inhaler use. Methods: A cross-sectional observational study of Australian adults with a current physician diagnosis of asthma receiving ࣙ2 prescriptions of FDC ICS/LABA therapy in the previous year, who were recruited through general practice to receive a structured in-depth asthma review between May 2012 and January 2014. Descriptive statistics and Chi-Square tests for independence were used for associations across asthma control levels. Results: Only 11.5% of the patients had controlled asthma based on guideline-defined criteria. Contrarily, 66.5% of the patients considered their asthma to be well controlled. Incidence of acute asthma exacerbations in the previous year was 26.5% and 45.6% of the patients were without a diagnosis of rhinitis. Asthma medication use and inhaler technique were sub-optimal; only 41.0% of the preventer users reported everyday use. The side effects of medication were common and more frequently reported among uncontrolled and partially controlled patients. Conclusions: The study revealed the extent to which asthma management needs to be improved in this patient cohort and the numerous unmet needs regarding the current state of asthma care. Not only there is a need for continuous education of patients, but also education of health care practitioners to better understand the way in which patient's perceptions impact on asthma management practices, incorporating these findings into clinical decision making.

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Section: Asthma Reviewmentioning

confidence: 99%

Lack of asthma and rhinitis control in general practitioner-managed patients prescribed fixed-dose combination therapy in Australia

Bosnic‐Anticevich

Kritikos

Carter³

et al. 2017

Journal of Asthma

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“…The first ones may decrease the clinical efficacy of a given inhaler, and the second ones make the inhalation practically totally clinically ineffective [24]. The DPI inhalation errors are mostly specific to a given type of inhaler but there are also some errors (non-specific), common to all DPI [25]. The most frequent non-specific errors include as follows: not taking a maximally deep expiration (to the level of the functional residual capacity [FRC]) before inhalation, incorrect body position during the inhalation, too slow or too shallow inspiration via the inhaler as well as not holding the breath after the inhalation [26].…”

Section: How Much Do the Errors In Inhalationmentioning

confidence: 99%

“…The most frequent non-specific errors include as follows: not taking a maximally deep expiration (to the level of the functional residual capacity [FRC]) before inhalation, incorrect body position during the inhalation, too slow or too shallow inspiration via the inhaler as well as not holding the breath after the inhalation [26]. The list of the specific errors is much more longer and depends on the type of DPI [25].…”

Section: How Much Do the Errors In Inhalationmentioning

confidence: 99%

“…For example, too weak inspiration (a suboptimal inspirational flow), which is one of the most frequent errors during the inhalation from the DPI, increases significantly the risk of uncontrolled asthma (OR [odds ratio] =1.30, 95% CI 0.08-1.57 for Turbuhaler ® and OR = 1.56, 95% CI 1.17-2.07 for Discus ® ), as well as it increases the risk of asthma exacerbations [25]. In another paper, the authors evidenced that patients who obtained only a suboptimal value of the PIF (for a given DPI) had an higher risk of COPD exacerbation, which demanded admission to the hospital [13].…”

Section: How Much Do the Errors In Inhalationmentioning

confidence: 99%

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Dry Powder Inhalers—Between the Doctor and the Patient

Emeryk

Pirożyński²,

Emeryk-Maksymiuk³

2018

Advances in Respiratory Medicine

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The article briefly presents currently accessible dry powder inhalers (DPI). Basing on the data from the literature, we discussed the most common mistakes related to the utilisation of DPI as well as their clinical and economic consequences. We also extensively analysed all factors that may influence the efficacy and safety of inhaler therapy of asthma and COPD, mostly with the use of DPI. In addition, we indicated the potential to improve the efficacy of inhaler therapy from the doctor and COPD or asthma patient perspective. We also presented a DPI choice algorithm including the patient's preferences and competences.

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“…This point is underlined by a recent study based on data from a multicentre crosssectional study of adults with asthma (iHARP). 11,12 A number of critical errors in inhaler use were identified which are related to an increased rate of asthma exacerbations. The study highlighted the importance of good training as part of primary and secondary care management to reduce the incidence of critical errors by patients.…”

Section: Desirable Inhaler Characteristics For Treating Asthmamentioning

confidence: 99%

Inhaler Characteristics in Asthma

Biddiscombe¹

2017

European Respiratory &Amp; Pulmonary Diseases

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The history of inhaled therapy goes back a surprisingly long way. More than 4,000 years ago, in India, the vapour of plants from the nightshade family placed on hot bricks was inhaled to alleviate breathing difficulties. The bronchodilators, derived from these plants, and compounds related to them, have played a significant part in therapeutic aerosol delivery over the years and remain important in the treatment of lung diseases today. The development of inhaled therapy has accelerated over the past 60 years with the arrival of the first truly portable inhaler in 1956 to relieve the symptoms of asthma. Initially, only bronchodilators were delivered from these devices, but as the true nature of asthma was revealed, inhaled corticosteroids were introduced to treat the underlying inflammation that is a major component of asthma. Further advances have led to long-acting bronchodilators becoming available, and combination therapies containing both longacting bronchodilators and corticosteroids in one inhaler. Asthma therapy has come a long way in a comparatively short time with over 230 device and drug combinations available for treating the disease. However, despite enormous investment asthma remains a huge healthcare problem. The number of people with asthma continues to grow with over 300 million people affected worldwide and 250,000 annual deaths attributed to the disease. It affects people of all ages and has a varying degree of severity. In this article, we look at the ideal characteristics for asthma inhalers and highlight some of the most important reasons for the failure of current asthma treatments.

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Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes

Abstract: Specific inhaler errors have been identified as critical errors, evidenced by frequency and association with asthma outcomes. Asthma management should target inhaler training to reduce key critical errors.

Cited by 243 publications

References 34 publications

Lack of asthma and rhinitis control in general practitioner-managed patients prescribed fixed-dose combination therapy in Australia

Lack of asthma and rhinitis control in general practitioner-managed patients prescribed fixed-dose combination therapy in Australia

Dry Powder Inhalers—Between the Doctor and the Patient

Inhaler Characteristics in Asthma

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