Validation of scores of use of inhalation devices: valoration of errors

Abstract

Objective: To validate two scores quantifying the ability of patients to use metered dose inhalers (MDIs) or dry powder inhalers (DPIs); to identify the most common errors made during their use; and to identify the patients in need of an educational program for the use of these devices. Methods: This study was conducted in three phases: validation of the reliability of the inhaler technique scores; validation of the contents of the two scores using a convenience sample; and testing for criterion validation and discriminant validation of these instruments in patients who met the inclusion criteria. Results: The convenience sample comprised 16 patients. Interobserver disagreement was found in 19% and 25% of the DPI and MDI scores, respectively. After expert analysis on the subject, the scores were modified and were applied in 72 patients. The most relevant difficulty encountered during the use of both types of devices was the maintenance of total lung capacity after a deep inhalation. The degree of correlation of the scores by observer was 0.97 (p < 0.0001). There was good interobserver agreement in the classification of patients as able/not able to use a DPI (50%/50% and 52%/58%; p < 0.01) and an MDI (49%/51% and 54%/46%; p < 0.05). Conclusions: The validated scores allow the identification and correction of inhaler technique errors during consultations and, as a result, improvement in the management of inhalation devices.

Evaluation of the preference, satisfaction and correct use of Breezhaler® and Respimat® inhalers in patients with chronic obstructive pulmonary disease – INHALATOR study

“…These results are in agreement with the study of Schulte et al that evaluated the correct usage of several dry powder inhalers [6]. Likewise, this reinforces the importance of patients' training and adaptation to the inhaler in reducing usage errors during the inhaler's assembling [14][15][16][17]. Nevertheless, it is important to emphasize that there is no consensus for which checklist is most appropriate to evaluate the correct use of inhaled devices.…”

“…Different checklists are used in several studies, but all take into account the characteristics described in the monographs of the products. Thus, despite the lack of consensus, data from various studies can be adequately comparable [15,[18][19][20].…”

Asma E a Técnica Inalatória Do Inalador Pressurizado Dosimetrado Acoplado Ao Espaçador: Revisão Integrativa

“…Zambelli-Simões L , Martins MC, Possari JCC, et al (23) Estudo de coorte Jornal Brasileiro de Pneumologia (2015)…”

“…Quanto à justificativa dos passos da técnica inalatória usados pelos artigos, seis utilizaram apenas referências da literatura (11)(12)14,16,(18)(19) ; um estudo, além de usar a literatura, validou a sequência de passos com quatro peritos (13) ; três artigos indicaram a escolha da técnica baseados em revisão de literatura e instruções de fabricantes em bulas (15,20,22) ; um artigo referenciou, além da literatura e instruções de fabricantes, um guideline (17) ; um estudo indicou que a técnica foi desenvolvida a partir de literatura revisada e experiência clínica de especialistas (21) ; e dois artigos referenciaram um guideline (23)(24) .…”

“…Quanto à idade do grupo de aplicação da técnica, verificou-se que três estudos (11,20,24) trabalharam tanto com crianças quanto adultos, um estudo (16) indicou ter aplicado em indivíduos com idade igual ou superior a 14 anos, oito estudos (12)(13)(14)(15)(18)(19)(22)(23) aplicaram em adultos e dois (17,21) em crianças.…”