Real‐life assessment of chronic obstructive pulmonary disease patient performance with different inhalers

Abstract

Purpose This study aimed to evaluate handling of six common inhalers and to determine correlations between correct inhaler technique and patient demographics/ clinical variables. Methods A total of 180 chronic obstructive pulmonary disease (COPD) patients were crossed‐over to handle their past‐experienced inhalers among (pMDI, Aerolizer, Handihaler, Breezhaler, Turbohaler, and Diskus) randomly, without receiving verbal or demonstrative instruction (baseline assessment). Inhaler technique was assessed using previously defined checklists. The correct use of the inhaler was then demonstrated and the patient was evaluated for inhaler use again. Demonstration was repeated until a correct technique was achieved. Number of counselling attempts needed to a complete right handling, patient demographics and clinical variables were recorded. Results The mean percentage of total correct steps showed that pMDI is significantly lower than all other inhalers (76.01 ± 12.61 vs 84.18 ± 10.87, 84.60 ± 12.10, 85.91 ± 9.82, 90.63 ± 9.29 and 91 ± 10.22 for Diskus, Turbohaler, Aerolizer, Handihaler and Breezhaler, respectively, at P < .001). Breezhaler showed the lowest percentage of participants with at least 1 critical error (20%) however, pMDI showed the highest percentage (85.19%) at P < .05. Breezhaler showed that the highest percentage of participants achieved a complete right handling after 1st counselling attempt, however, pMDI was the only inhaler included in a 3rd and 4th counselling attempts (5.93% and 0.74%, respectively). Weak and very weak correlations were found between total correct steps and demographics/clinical variables. Conclusions pMDI is not preferable for handling by COPD patients. DPIs vary in ease of use, so that inhaler therapy must be individualised on basis of patient handling assessment with repeated counselling.

Determinants of incorrect inhaler technique in chronic obstructive pulmonary disease patients

“…3 Also, Respimat and pMDIs are not breath-actuated like DPIs; they require additional patient skills and coordination to initiate the drug delivery which was an obstacle in the majority of the elderly population being elderly with multiple comorbidities hindering their physical capabilities with poor hand-lung coordination. 32,34,37,57 The incidence of incorrect technique was lower with pMDI compared with Respimat (93.33% vs 100%, respectively), unlike previous reports, 3,20 because of differences in past-experience of our study participants with pMDIs Vs. Respimat (75% vs 0%, respectively). Our data emphasise that a proper use of one inhaler is not necessarily translated into…”

“…62 Subject education and training on correct inhaler technique significantly improves their skills for all inhalers, repeated counselling could overcome all challenging patient-related or inhaler-related factors confirming that repeated counselling is a crucial aspect of treatment efficacy, and prescribers should repeatedly verify the patients' proficiency in the use of inhalers with a focus on the commonly reported errors (difficult steps). 3,12,20,32,[63][64][65] Finally, it was found that lack of a past-experience to inhaler was the strongest determinant of an incorrect inhaler technique followed by the type of inhaler; Respimat, Diskhaler, Discus and pMDI use are most likely leading to an incorrect inhaler technique, unlike…”

“…This is consistent with previously published studies applying both correlation study and regression analysis. 3,26,32 It is more likely that cognitive functions are more contributing to inhaler mishandling than the clinical state of the subject. 26 The only clinical parameter involved in the regression model as a significant determinant of incorrect inhaler technique was the GOLD group which is an unexpected result on basis of poor association with all clinical parameters and disagrees with previous findings.…”

“…However, other studies could not confirm these associations. 3,13,[29][30][31][32] Consequently, this discrepancy reflects a lack of a comprehensive overview of the most important inhaler-related and patientrelated determinants of incorrect inhaler techniques among COPD subjects. Such an overview may guide health-care providers for better inhaler device selection and to identify patients who need an extra-attention, well-training and repeated education about proper inhaler use.…”

The Effect of Adding a Training Device and Smartphone Application to Traditional Verbal Counseling in Asthmatic Children

“…MDI inhalation technique differs very much from that of the dry powder inhaler, especially in the inhalation flow required to deliver the dose [10][11][12][13][14][15]. Incorrect utilization of inhalers can be noted between all ages of patients, but it appears more frequently within children and older patients [16][17][18][19].Some previous studies have shown that most repeated inhalation technique mistakes were the inability in actuation coordination of MDI at the time of inhalation, maintaining the needed inhalation flow for a sufficient period, the period of holding the breath after inhalation is shorter than recommended, and missing shaking of the MDI before use to mix the contents [20][21][22][23]. The patient's ability to inhale the aerosolized drug deeply and steadily for 5 s is a key step in the inhalation process, as faster inhalation speed will decrease the portion of drug delivered to the lungs, which leads to poor asthma control [21,24].…”