Systematic review of association between critical errors in inhalation and health outcomes in asthma and COPD

Kocks, Janwillem; Chrystyn, Henry; Palen, Job van der; Thomas, Mike; Yates, Louisa; Landis, Sarah H.; Driessen, Maurice; Gokhale, Mugdha; Sharma, Raj Kumar; Molimard, Mathiéu

doi:10.1038/s41533-018-0110-x

Cited by 78 publications

(94 citation statements)

References 34 publications

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“…Inhaler misuse and poor adherence were associated with an increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), oral steroids (p < 0.001) and antimicrobial agents (p < 0.001) and poor disease control [2]. In contrast, patients who achieved a reduction in errors over time had improved outcomes [7]. In addition to the error rate when using inhalers, the patient's adherence to inhaler device therapy also plays an important role.…”

Section: Introductionmentioning

confidence: 99%

Inhaler devices in asthma and COPD patients – a prospective cross-sectional study on inhaler preferences and error rates

2020

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Background: Inhalation therapy is the backbone of asthma and COPD control. However, inhaler adherence and device mishandling continue to be a problem in real life. Some studies have shown that using a patient-preferred inhaler may reduce device handling errors and improve adherence to prescribed chronic inhaler drug therapy. The aim of this study was to compare the preferences for commonly used inhaler devices in Germany in patients with chronic obstructive respiratory disease. We also pursued the question which properties of an inhaler device are particularly important to the user and what effects age, gender and type of disease (asthma or COPD) may have on device preference and handling errors. Methods: Prospective, open-label cross-sectional study in which 105 patients with asthma (58%) or COPD (42%) participated. Validated checklists were used to objectively assess inhaler technique and errors with 10 different placebo devices. For each device, patients were asked to test the handling, to assess the device properties and to name the device that they would most or least prefer. Results: Across the 10 placebo inhaler devices tested, patients needed an average of 1.22 attempts to error-free use. The device with the lowest mean number of attempts was the Turbohaler® (1.02), followed by the Nexthaler® (1.04), the Diskus® (1.07) and the Spiromax® (1.10). Patients over 60 years vs. younger age (p = 0.002) and COPD vs. asthma patients (p = 0.016) required more attempts to ensure correct use. 41% of the study participants chose one of the devices they already used as the most preferred inhaler. Overall, 20% opted for the Spiromax®, 15% for the Nexthaler® and 14% for the Turbohaler® or a pMDI. The least preferred device was the Elpenhaler® (0%). From a selection of 7 predefined inhaler attributes, patients stated easy handling as the most important for them. This was followed by short inhalation time and low inhalation resistance. Conclusions: Patient preference may vary between inhaler devices. The lowest number of attempts to error-free use was reported for the Turbohaler® and the Nexthaler®. The Spiromax® and the Nexthaler® achieved the best overall ratings and were the devices most preferred by patients.

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Section: Introductionmentioning

confidence: 99%

Inhaler devices in asthma and COPD patients – a prospective cross-sectional study on inhaler preferences and error rates

2020

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“…Overall (children & adults, asthma & COPD) there is evidence that poor inhaler technique is associated with adverse outcomes. Kocks et al recently reported a systematic review of studies linking inhaler technique, assessment of errors, and disease outcomes (the majority studies being in asthmatics) (15). Although the 12 asthma studies had various outcomes most studies reported that inhalation errors were associated with worse disease outcomes.…”

Section: Key Question 3 Does It Matter If a Child's Inhaler Techniqumentioning

confidence: 99%

Aerosol Therapy in Asthma–Why We Are Failing Our Patients and How We Can Do Better

et al. 2020

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“…Inhaler handling errors and non-adherence can affect drug delivery and minimize treatment bene ts [5,6]. A large number of studies reported that inhaler errors came along with worse disease outcome in asthma or COPD patients [7]. Inhaler misuse was associated with an increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), oral steroids (p < 0.001) and antimicrobial agents (p < 0.001) and poor disease control [2].…”

Section: Introductionmentioning

confidence: 99%

“…Inhaler misuse was associated with an increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), oral steroids (p < 0.001) and antimicrobial agents (p < 0.001) and poor disease control [2]. In contrast, patients who achieved a reduction in errors over time had improved outcomes [7]. In addition to the error rate when using inhalers, the patient's adherence to inhaler device therapy also plays an important role.…”

Section: Introductionmentioning

confidence: 99%

Inhaler devices in asthma and COPD patients – A prospective cross-sectional study on inhaler preferences and error rates

Schreiber

Roessler

Luecke

2020

Preprint

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Background: Inhalation therapy is the backbone of asthma and COPD control. However, inhaler adherence and device mishandling continue to be a problem in real life. Some studies have shown that using a patient-preferred inhaler may reduce device handling errors and improve adherence to prescribed chronic inhaler drug therapy. The aim of this study was to compare the preferences for commonly used inhaler devices in Germany in patients with chronic obstructive respiratory disease. We also pursued the question which properties of an inhaler device are particularly important to the user and what effects age, gender and type of disease (asthma or COPD) may have on device preference and handling errors.Methods: Prospective, open-label cross-sectional study in which 105 patients with asthma (58%) or COPD (42%) participated. Validated checklists were used to objectively assess inhaler technique and errors with 10 different placebo devices. For each device, patients were asked to test the handling, to assess the device properties and to name the device that they would most or least prefer.Results:Across the 10 placebo inhaler devices tested, patients needed an average of 1.22 attempts to error-free use. The device with the lowest mean number of attempts was the Turbohaler® (1.02), followed by the Nexthaler® (1.04), the Diskus® (1.07) and the Spiromax® (1.10). Patients over 60 years vs. younger age (p=0.002) and COPD vs. asthma patients (p=0.016) required more attempts to ensure correct use. 41% of the study participants chose one of the devices they already used as the most preferred inhaler. Overall, 20% opted for the Spiromax®, 15% for the Nexthaler® and 14% for the Turbohaler® or a pMDI. The least preferred device was the Elpenhaler® (0%). From a selection of 7 predefined inhaler attributes, patients stated easy handling as the most important for them. This was followed by short inhalation time and low inhalation resistance. Conclusions: Patient preference may vary between inhaler devices. The lowest number of attempts to error-free use was reported for the Turbohaler® and the Nexthaler®. The Spiromax® and the Nexthaler® achieved the best overall ratings and were the devices most preferred by patients.

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Systematic review of association between critical errors in inhalation and health outcomes in asthma and COPD

Cited by 78 publications

References 34 publications

Inhaler devices in asthma and COPD patients – a prospective cross-sectional study on inhaler preferences and error rates

Inhaler devices in asthma and COPD patients – a prospective cross-sectional study on inhaler preferences and error rates

Aerosol Therapy in Asthma–Why We Are Failing Our Patients and How We Can Do Better

Inhaler devices in asthma and COPD patients – A prospective cross-sectional study on inhaler preferences and error rates

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