Critical inhaler technique errors in Swedish patients with COPD: a cross-sectional study analysing video-recorded demonstrations

Abstract

A correct use of inhaler devices is essential in chronic obstructive pulmonary disease (COPD) treatment. Critical errors were studied by analysing 659 video-recorded demonstrations of inhaler technique from 364 COPD patients using six different inhaler device models. The majority of the included patients used two (55%) or more (20%) device models. Overall, 66% of the patients made ≥1 critical error with at least one device model. The corresponding numbers for patients using 1, 2 and ≥3 device models were 43%, 70% and 86%, respectively. The only factor associated with making ≥1 critical error was simultaneous use of two (adjusted odds ratios (aOR) 3.17, 95% confidence interval (95% CI) 1.81, 5.64) or three or more (aOR 8.97, 95% CI 3.93, 22.1) device models. In conclusion, the proportion of patients making critical errors in inhaler technique was substantial, particularly in those using several different device models. To obtain optimal COPD treatment, it is important to assess a patient’s inhaler technique and to minimise the number of inhaler device models.

Changes in critical inhaler technique errors in inhaled COPD treatment – A one-year follow-up study in Sweden

“…The Tools Identifying Exacerbations (TIE) study is a prospective, observational cohort study in primary and secondary care outpatients with COPD performed in the regions of Dalarna, Gävleborg, and Uppsala in Sweden [6,26,27]. The enrolment of patients started in 2014 with a baseline visit and a follow-up visit one year after study inclusion.…”

“…Dry-powder inhalers, soft-mist inhalers, and pressurized metereddose inhalers are different drug formulations [3] commonly used in the treatment of COPD [6][7][8][9][10][11][12][13]. Critical inhaler technique errors, which can be either generic or device-specific, are a result of incorrect device handling [3,14] and should be avoided as they may lead to lower treatment efficacy [4,5].…”

“…Critical inhaler technique errors, which can be either generic or device-specific, are a result of incorrect device handling [3,14] and should be avoided as they may lead to lower treatment efficacy [4,5]. Unfortunately, incorrect inhaler use is common [4,[6][7][8][9][10][11]13,15] and has been a problem for several decades [16]. Studies with a retrospective study design have found high inhaler error frequencies to be associated with poor disease outcomes in asthma [4,14], unplanned health care contacts related to asthma and COPD [17], and severe exacerbations in COPD [11].…”

Cost-Effectiveness of Single- versus Multiple-Inhaler Triple Therapy in a UK COPD Population: The INTREPID Trial

“…4 Triple therapy has previously required the use of multiple inhalers; however, multiple inhaler use is associated with poorer persistence and adherence, and an increased potential for critical inhaler errors compared with the use of single inhalers. [5][6][7] Poor treatment adherence and errors in inhalation technique are associated with increased exacerbations, more hospitalizations, and higher healthcare costs in patients with COPD. [8][9][10][11] In 2017, single-inhaler triple therapy (SITT) with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI; GSK, Brentford, Middlesex, UK) was approved for the long-term maintenance treatment of patients with COPD in the UK.…”

The Impact of an Educational Intervention on the Skill of Community Pharmacists in the Use of a Pressurized Metered-dose Inhaler: A Covert Simulated Patient Approach in Pakistan

“…An appropriate inhaler technique is essential to achieve desired results for the management of asthma. 4 The optimal inhaler technique requires essential steps to be performed in a coordinated way for the proper delivery of active pharmaceutical agents to the bronchioles for desired outcomes. Suboptimal inhaler technique may result in reduced drug delivery, low efficacy and consequently poor disease control with increased hospitalization.…”