Irregular and Ineffective: A Quantitative Observational Study of the Time and Technique of Inhaler Use

Sulaiman, Imran; Seheult, Jansen N.; MacHale, Elaine; D’Arcy, Shona; Boland, Fiona; McCrory, Katrina; Casey, John; Bury, Gerard; Al‐Alawi, Mazen; O'Dwyer, Susan; Ryder, Sheila A.; Reilly, Richard B.; Costello, Richard W.

doi:10.1016/j.jaip.2016.07.009

Cited by 65 publications

(66 citation statements)

References 29 publications

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“…This has important implications, as poor technique has been linked to poor disease control,[1, 2, 35] and when combined with poor adherence, results in high medical costs and missed opportunities for disease management. [10] The odds of making these errors vary by race and educational background—a finding which opens the door to implementing evidence-based, tailored educational interventions to improve technique. Poor inhaler technique may therefore be a significant contributor to worse outcomes among patients with poor health literacy, but may not be a sole barrier to improving technique.…”

Section: Discussionmentioning

confidence: 99%

“…[8, 9] MDIs need to be shaken before use, but shaking or tipping the Advair Diskus may result in loss of the medication. Unfortunately, many patients are not optimally adherent to inhaled therapies, missing doses or not using medications as directed,[10] with some studies finding rates of misuse as high as 80%. [11-13] Assuring correct inhaler technique is therefore an important aspect of the management of these patients.…”

Section: Introductionmentioning

confidence: 99%

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Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD

Melzer

Ghassemieh

Gillespie

et al. 2017

Respiratory Medicine

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Background Inhaled therapies are the cornerstone of pharmacologic management for COPD. Each device requires a unique series of steps to be most effective, making appropriate instruction in inhaler technique a key part of the management of COPD. Objectives Examine characteristics of patients and devices associated with poor technique among patients with COPD. Methods Cross-sectional study of subjects with COPD using at least one of: metered dose inhaler, Advair Diskus, Spiriva Handihaler, identified from the COPD Outcomes-based Network for Clinical Effectiveness and Research Translation (CONCERT) registry. Technique was assessed face-to-face using manufacturer-provided dummy inhalers, with standardized checklists for each device. We used logistic regression to model associations with poor inhaler technique, defined as an error in ≥20% of the steps, as a function of patient characteristics, with educational attainment the primary predictor. Results 688 individuals meet eligibility criteria, 65.5% had poor technique for at least one device. In adjusted analyses, Black race was associated with poor technique (OR 3.25, 95%CI 1.86-5.67) while greater than high school education was associated with decreased odds of poor technique (OR 0.35, 95%CI 0.17-0.70 for trade school/some college, OR 0.25, 95%CI 0.11-0.61 for college or more, p≤0.001 for test of linear trend). The percentage of errors varied between devices, with subjects making proportionally the most errors for MDIs. Conclusions Poor inhaler technique is common among individuals with COPD, varies between devices, and is associated with race and educational attainment. Tailored educational interventions to teach inhaler should be part of the process of initiating and monitoring inhaled therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD

Melzer

Ghassemieh

Gillespie

et al. 2017

Respiratory Medicine

View full text Add to dashboard Cite

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“…[3][4][5][6][7][8][9] For respiratory patients, some scholars argue for the incorrect use of inhalers to be a form of poor adherence or non-adherence. 9,10 Whereas a third group of scholars [27][28][29][30][31] highlight that the notion of what is called true adherence incorporates two distinct components namely adherence and competence, with competence mainly being related to the patient's ability to use a medication in a correct and effective way, which is also commonly referred to as technique. 9,10 Whereas a third group of scholars [27][28][29][30][31] highlight that the notion of what is called true adherence incorporates two distinct components namely adherence and competence, with competence mainly being related to the patient's ability to use a medication in a correct and effective way, which is also commonly referred to as technique.…”

Section: Introductionmentioning

confidence: 99%

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

et al. 2019

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Background: Problems related to poor adherence and inhaler technique (IT) are historically reported in the literature. Most common methods used for adherence and IT assessment are reported to be either inaccurate or subjective. Few electronic monitoring devices (EMDs) that provide an objective measure of both adherence and IT while patients use inhalers at home now exist. Therefore, this study aimed to examine adherence level and IT among respiratory patients in community care using such an EMD for the first time in England. Methods:A prospective, multicentre, observational cohort study was conducted.Patients with chronic obstructive pulmonary disease (COPD) or asthma were recruited from independent community pharmacies within West and South London.Patients were provided with a dry-powder inhaler (DPI) mounted with an EMD to use for 1 month. Adherence was also assessed using pharmacy dispensing data, inhaler dose counter and self-reporting.Results: Data were available for 48 patients. Only eight patients used their inhaler in the correct manner at the correct interval as identified by the chosen EMD. The median actual adherence rate, as measured by the EMD, was 42.7%. This was significantly different from the median dose counter adherence (100%), medication refill adherence (MRA) (100%), proportions of days covered (PDC) (97.8%) and self-reported adherence (P < .001, each). Within a 1-month period, there were 2188 files showing attempted use of the DPI, of which 840 had IT errors. The median technique error rate (TER) was 30.1%. Most common errors recorded were as follows: multiple inhalations, drug priming without inhalation and failure to prime the device correctly. Conclusion:The current study demonstrates that measures such as dose counter, prescription refill and self-reporting showed a high level of adherence among the observed patients. However, the objective data provided by the EMD showed a significantly lower actual adherence rate, reflecting how adherence remains variable and problematic among patients in the community.

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“…Recent estimates suggested that 70–80% of patients with asthma or COPD do not use their inhalers correctly [8-10]. Furthermore, physicians often do not review whether patients are using their inhalers correctly [11, 12], so it is important that patients find the inhaler easy to use during the initial learning phase and long-term use.…”

Section: Introductionmentioning

confidence: 99%

Patient Satisfaction and Clinical Outcomes with Budesonide plus Formoterol Spiromax for Asthma and Chronic Obstructive Pulmonary Disease: A Real-World, Observational Trial

et al. 2018

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Background: The fixed-dose combination of budesonide/formoterol (B/F) has been available in the Spiromax® dry powder inhaler since 2014. Objectives: To assess patient satisfaction, inhaler use errors, and disease control in patients with asthma or chronic obstructive pulmonary disease (COPD) treated with B/F Spiromax. Methods: This non-interventional, prospective, 12-week study enrolled consecutive asthma or COPD patients who had recently begun treatment with B/F Spiromax or were switched from another inhaled corticosteroid/long-acting β₂-agonist combination to B/F Spiromax in routine clinical practice. Patients recruited from 243 specialist respiratory clinics or general practices in Germany were assessed for patient satisfaction (Satisfaction with Inhalers and Preference questionnaire), inhaler application errors (modified Easy Low Instruction over Time checklist), disease control, and safety. Results: The population included 3,943 patients: asthma n = 2,707 (68.7%); COPD n = 1,236 (31.3%). At baseline, 60.1% of patients were “satisfied” or “very satisfied” with their previous inhaler, and this increased to 88.8% at week 12 of B/F Spiromax use. Overall, 62.1% of pre-treated patients preferred B/F Spiromax to their old inhaler. The frequency of any handling error observed with B/F Spiromax at week 12 was lower than at baseline (11.9 vs. 25.5% of patients, respectively). After 12 weeks, 77.4% were assessed as having improved (minimally, much, or very much) overall health status versus baseline. Guideline-defined disease severity (as rated by physicians) and patient-reported symptom severity improved during the study in both asthma and COPD patients. B/F Spiromax was well tolerated. Conclusion: B/F Spiromax was associated with high patient satisfaction, low device handling error rate, and improvements in clinical outcomes in real-world clinical practice.

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Irregular and Ineffective: A Quantitative Observational Study of the Time and Technique of Inhaler Use

Cited by 65 publications

References 29 publications

Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD

Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

Patient Satisfaction and Clinical Outcomes with Budesonide plus Formoterol Spiromax for Asthma and Chronic Obstructive Pulmonary Disease: A Real-World, Observational Trial

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