Assessment of Proper Medication Inhaler Technique in Adult Patients

Abstract

Background: Many medications used to manage pulmonary disease are delivered via unique inhalation devices. Proper technique in using these devices is required for effective medication delivery. Objective: To assess the degree of proper inhaler technique among adult patients. Methods: Patients using inhalers were identified and then interviewed by pharmacy personnel regarding inhaler use. Checklists were used to document the adherence to manufacturers' directions for each respective inhaler, and data were then tabulated and assessed for the number and types of inhalers used, incorrectly performed steps in using the inhalers, as well as demographic information of patients. Results: Of the 129 patients that were interviewed, a total of 212 inhalers were used. Twenty-five percent of inhalers (/212) were used incorrectly, with the 3 most common errors being improper priming or lack of test sprays, lack of proper exhalation prior to inhaling the medication, and absence or improper cleaning of inhalers. Furthermore, less than 4% of patients reported being instructed by a pharmacist on proper inhaler use. Conclusion: Inhaler technique among adult patients is substandard and is a key area for pharmacists to become more proactive in educating patients.

Device use errors with soft mist inhalers: A global systematic literature review and meta-analysis

“…For studies that did not provide an overall error rate, [41][42][43] it was inferred based on the reported inhalation step with the highest frequency of error. For one study, 44 the overall device use error was considered the same as the reported error rate from the single inhalation step for which data were provided. That study also reported patients using Spiriva without specifying whether the medication was delivered via Respimat or Handihaler ® .…”

“…Among these articles, 33 did not provide information on device use errors, resulting in a total of 12 publications that were included in this meta-analysis. 22,[39][40][41][42][43][44][45][46][47][48][49] Since this study involved reviewing aggregate level secondary data published in publicly available studies and there was no access to primary patient-level data, protocol approval by the Institutional Review Board and Ethical Committee was waived.…”

“…Significant heterogeneity was observed across the 12 studies included in our meta-analysis (I 2 ¼ 92.8%; test for heterogeneity: Q(df ¼ 11): 273.6, p < 0.001). Sensitivity analysis revealed that the pooled effect size was altered with the removal of five studies 22,39,41,44,49 (Figure 4). The resulting overall effect size was 57.5% (95% CI: 21.2-93.9) across the five studies relative to 59.8% (95% CI: 51.3-68.4) for the remaining seven studies.…”

An evaluation of proper inhaler technique and adherence to treatment in asthma patients

“…12 Lack of proper exhalation prior to inhalation was one among the three most common errors in 25% of the inhaler users. 23 Hence, a need to emphasize on this step for proper use of inhaler device is essential. Of 120 patients interviewed, only 60% adherent to asthma medications.…”

Evaluation of relationship of inhaler technique with asthma control and quality of life

“…[ 9 ] Lack of proper exhalation prior to inhalation was one among the three most common errors in 25% of the inhaler users. [ 17 ]…”