Inhaler mishandling is very common in patients with chronic airflow obstruction and long-term home nebuliser use

Abstract

Inhalers and nebulisers are devices used for delivering aerosolised drugs in subjects with Chronic Airflow Obstruction (CAO). This multicentre, cross-sectional observational study was performed in a large population of outpatients with CAO regularly using home aerosol therapy and referring to chest clinics. The aims of the study were to compare the characteristics of the group of subjects with CAO who were using home nebulisers but also experienced with inhalers vs. those only using inhalers and to investigate whether the first group of subjects was particularly prone to inhaler misuse. Information was gained evaluating the responses to a standardised questionnaire on home aerosol therapy and the observations of inhaler technique. We enrolled 1527 patients (58% males; mean ± SE; aged 61.1 ± 0.4 years; FEV1% pred 69.9 ± 0.6; 51% and 44% respectively suffering from COPD and asthma) who were only inhaler users (OIU group) and 137 (85% males; aged 67.7 ± 1.3 years; FEV1% pred 62.3 ± 2.9; 60% and 23% respectively suffering from COPD and asthma) who were using both nebulisers and inhalers (NIU group). Nebuliser users were older, had more severe obstruction, related symptoms and health care resources utilisation. Nebulisers users performed more critical inhalers errors than those of the OIU group (49% vs. 36%; p = 0.009). We conclude that our patients with CAO and regular nebuliser treatment had advanced age, severe respiratory conditions and common inhaler misuse.

A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices

“…Between 36 and 49% of patients with COPD perform critical inhaler errors with currently used inhalers, 18,19 and in a review of studies by Cochrane et al 20 efficient inhalation technique was demonstrated by only 46–59% of asthma patients. The development of an easy-to-use inhaler device that delivers the drug to the lungs effectively is important.…”

Health coaching to improve self-management and quality of life for low income patients with chronic obstructive pulmonary disease (COPD): protocol for a randomized controlled trial

“…Patient-reported measures include the Short Form Chronic Respiratory Disease Questionnaire [19], a chronic disease self-efficacy scale [20] adapted to COPD, COPD Assessment Test [21, 22], the short version of the Patient Assessment of Chronic Illness Care (PACIC) [23], the Patient Health Questionnaire (PHQ-8) [24], the Generalized Anxiety Disorder Scale [25], the Morisky Medication Adherence Scale [26, 27], the Trust in Physician Scale [28, 29], a single-item health literacy screener [30], and a modified version of an inhaler use checklist [31]. The timeline of these measures is shown in Table 1 below.…”

Safeguarding the process of drug administration with an emphasis on electronic support tools

“…However, while Hawthorne effects have been described , these effects seem to be reducible if the observation spans across a longer period of time . Direct observation can also be employed with patients or family members to detect administration errors when using inhalers , insulin pens , eye drops , parenteral drugs or per oral drugs , for instance. Such assessments form the basis to describe the epidemiology of administration errors as well as other influencing variables and are essential to describe the benefit of potential error prevention strategies.…”