Breathing Out Completely Before Inhalation: The Most Problematic Step in Application Technique in Patients With Non-Mild Chronic Obstructive Pulmonary Disease

Abstract

Background: Patient adherence to an inhaled medication application technique (A-ApplT) represents a major health-care issue in patients with chronic obstructive pulmonary disease (COPD). However, there is a lack of studies evaluating this issue thoroughly. The aim of our study was to introduce a universal easy-to-use method of assessing the A-ApplT to chronic medication in moderate to very severe COPD individuals.Methods: The Czech Multicenter Research Database of COPD (COPD CMRD), a large observational prospective study, was used as a source of clinical data. A-ApplT was evaluated using our Five Steps Assessment. This measure is based on dichotomous evaluation of each of five predefined consecutive application technique steps and can be used in all settings for all currently available inhalation systems in COPD subjects.Results: A total of 546 participants (75.0% men; mean age 66.7 years; mean forced expiratory volume in 1s 44.7%) were available for analysis. This represents 69.6% of all patients recruited in the COPD CMRD. Less than one third of patients presented their application technique without any erroneous steps. The most problematic steps were breathing out completely in one breath immediately before inhalation (step No. 3), and the actual inhalation maneuver (step No. 4). The total number of errors was similar for dry powder inhalers and pressurized metered-dose inhalers.Conclusion: Our novel instrument, Five Steps Assessment, is comfortable for use in routine clinical practice to explore A-ApplT. The A-ApplT in real-life patients with non-mild COPD was inadequate and patients should be repeatedly trained by properly (re-)educated medical staff.

Chronic obstructive pulmonary disease - diagnosis and management of stable disease; a personalized approach to care, using the treatable traits concept based on clinical phenotypes. Position paper of the Czech Pneumological and Phthisiological Society

“…They require slow and deep breathing in for at least 4 seconds and they are the method of choice for patients with low inspiratory flow. The dry powder inhalers (DPI group) comprise several types of inhalers: Handihaler, Aerolizer, Breezhaler, Diskus, Turbuhaler, Ellipta, Genuair, Twisthaler, Easyhaler or Spiromax [150][151][152] .…”

“…cz/plic/aplikace-inhalacnich-leku-edukacni-videa/englishversions (animated version for patients) and the version for health-care professionals in an article by Vytrisalova et al (Table 3) (ref. 150 ).…”

“…• We propose the use of a previously validated and published unique novel scoring instrument -Five Steps Assessment 150 .…”

Investigating the validity and reliability of the traditional checklist for assessment of specific inhalation techniques with pressurized metered-dose inhalers using the Aerosol Inhalation Monitor

“…Inhaler techniques must be rechecked and education must be reinforced regularly to maintain correct technique, since inhaler technique deteriorates again after education [3,11]. Improper use of inhalation devices may lead to poor control of asthma and COPD, with decreased quality of life, greater medical expenditures, increased hospitalization risk, and higher drug doses being prescribed [8,12]. Therefore, inhalation techniques must be assessed and a validated instrument for assessment is required to avoid over-or underestimation of the accuracy.…”

“…Many inhalation devices have emerged in recent years, each having speci c requirements to ensure the drug is delivered to the lungs [3][4][5][6][7][8][9]. Inhalers should be prescribed only after patients have been trained to use them properly [10].…”