The Importance of Inhaler Devices: An Incorrect Inhaler Technique Leads to Suboptimal Medication Compliance In Patients With Copd

Objectives: Correct use of inhaler devices is critical in ensuring the optimal lung bioavailability of the inhaled drug. The study aimed to assess inhaler technique used in patients with using metered-dose inhalers (MDI) by correlating with urinary salbutamol excretion post inhalation and its correlation with disease control. Methods: Thirty patients with obstructive pulmonary diseases attending outpatients’ services inhaled two doses of salbutamol 100 µg and urine samples were collected after 30 min. Inhaler technique scores were assessed using a standardized 8-point checklist. The 30-minute concentration of urinary salbutamol is then correlated with inhaler technique scores and control status of the disease. Key findings: The mean age of the subjects was 60.8 (SD ± 9.338). The mean (SD) 30 min urinary salbutamol concentration was 3.6±1.6 µg/ml. The mean concentration of salbutamol was found to be 2.3 µg/ml (n=1), 2.3 µg/ml (n=5), 3.1 µg/ml (n=7), 3.9 µg/ml (n=8), 4.7 µg/ml (n=5), 5.3 µg/ml (n=3), and 5.0 µg/ml (n=1) among patients performing 1, 2, 3, 4, 5, 6, 7, 8 steps correctly, respectively. There was a statistically significant correlation (p=0.028) witnessed between the mean 30 min urinary salbutamol concentration and total correct steps. The frequency of exacerbation, use of antibiotics, and oral corticosteroids (OCS) were more in patients with poor inhaler technique scores, although statistical significance was achieved only for frequency of antibiotics use (p=0.032). Conclusions: The 30 min salbutamol urinary concentration evaluation may help to identify patients who were underdosed due to poor handling of inhaler devices. Being a complex procedure, it can at least be initiated in patients reporting frequent exacerbations, hospitalization, and those who need multiple drugs for disease control.

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Is there potential to use augmented reality technology to provide demonstrative inhaler technique education for asthma patients? A qualitative study (Preprint)

10.2196/preprints.34958 ◽

2021 ◽

Author(s):

Zoe Kopsaftis ◽

Antonia O'Connor ◽

Kelsey Jayne Sharrad ◽

Charmaine King ◽

Assoc. Prof. Carson-Chahhoud

Keyword(s):

Augmented Reality ◽

Disease Management ◽

Health Professionals ◽

Clinical Care ◽

Service Utilisation ◽

Inhaler Technique ◽

Community Stakeholders ◽

Asthma Patients ◽

Augmented Reality Technology ◽

Inhaler Devices

BACKGROUND Many people with asthma use incorrect inhaler technique resulting in sub-optimal disease management and increased health service utilisation. Novel ways of delivering appropriate instructions are needed. OBJECTIVE This study explores stakeholder perspectives on the potential use of augmented reality (AR) technology to improve asthma inhaler technique education. METHODS Based on existing evidence and resources, an information poster displaying the images of 22 asthma inhaler devices was produced. Using AR technology via a free smartphone application, the poster launched video demonstrations of correct inhaler technique for each device. Twenty‐one semi‐structured, one‐on‐one interviews with health professionals, people with asthma and key community stakeholders were conducted and data was analysed thematically using the Triandis model of interpersonal behaviour. RESULTS People with asthma believed they were competent with inhaler technique. However, health professionals and key community stakeholders identified that this perception was misguided and facilitates persistent incorrect inhaler use and sub‐optimal disease management. Delivering inhaler technique education using augmented reality was favoured by all participants, particularly around ease of use, with the ability to visually display inhaler techniques for each device. However, all participants identified some barriers, particularly for access and appropriateness of AR for older people. CONCLUSIONS Augmented reality technology may be a novel means to address poor inhaler technique among certain cohorts of asthma patients and serve as a prompt for health professionals to initiate review of inhaler devices. A randomised controlled trial design is needed to evaluate efficacy of this technology for use in the clinical care setting.

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Inhaler devices in asthma and COPD – An assessment of inhaler technique and patient preferences

Respiratory Medicine ◽

10.1016/j.rmed.2014.04.019 ◽

2014 ◽

Vol 108 (7) ◽

pp. 968-975 ◽

Cited By ~ 49

Author(s):

Pedro Chorão ◽

Ana M. Pereira ◽

João A. Fonseca

Keyword(s):

Patient Preferences ◽

Inhaler Technique ◽

Inhaler Devices

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Matching Inhaler Devices with Patients: The Role of the Primary Care Physician

Canadian Respiratory Journal ◽

10.1155/2018/9473051 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 14

Author(s):

Alan Kaplan ◽

David Price

Keyword(s):

Primary Care ◽

Treatment Success ◽

Primary Care Providers ◽

Care Physician ◽

Chronic Obstructive ◽

Inhaler Technique ◽

Care Providers ◽

Obstructive Pulmonary Disease ◽

Inhaler Devices

Poor inhaler technique and nonadherence impair the efficacy of medications for asthma and chronic obstructive pulmonary disease (COPD). A range of factors, including age, dexterity, inspiratory capacity, cognitive ability, health literacy, and ethnicity, can impact a patient’s ability and intention to use their device. Treatment success can also be influenced by patient preferences and perceptions. Therefore, it is important that healthcare professionals effectively match inhaler devices to individual patients’ needs and abilities and empower patients by including them in treatment decisions. Physicians must, therefore, fully understand the characteristics of each device, as well as their patients’ demographic characteristics and comorbidities. Following device selection, patient training and education, including a physical demonstration of the device, are key to eliminate any critical errors that may impact on health outcomes. Inhaler technique should be frequently rechecked. This review will examine the important role of primary care providers in the selection of appropriate inhaler devices and provision of training for patients with COPD and asthma to optimize correct inhaler use and adherence. An overview of the key features of available devices and of the factors to consider when selecting devices will be provided in the context of current asthma and COPD guidelines.

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Identification of Factors Involved In Medication Compliance: Incorrect Inhaler Technique of Asthma Treatment Leads to Poor Compliance

Value in Health ◽

10.1016/j.jval.2015.09.706 ◽

2015 ◽

Vol 18 (7) ◽

pp. A362-A363

Author(s):

J Darba ◽

G Ramírez ◽

A Sicras-Mainar ◽

L Garcia-Bujalance ◽

S Torvinen ◽

...

Keyword(s):

Medication Compliance ◽

Poor Compliance ◽

Inhaler Technique ◽

Asthma Treatment

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Confidence of nurses with inhaler device education and competency of device use in a specialised respiratory inpatient unit

Chronic Respiratory Disease ◽

10.1177/14799731211002241 ◽

2021 ◽

Vol 18 ◽

pp. 147997312110022

Author(s):

Vinita Swami ◽

Jin-Gun Cho ◽

Tracy Smith ◽

John Wheatley ◽

Mary Roberts

Keyword(s):

Cross Sectional Study ◽

Inpatient Unit ◽

Strongly Correlated ◽

Inhaler Technique ◽

Sectional Study ◽

Cross Sectional ◽

Inhaler Device ◽

The Mean ◽

Device Use ◽

Inhaler Devices

We performed a cross-sectional study within a specialised respiratory inpatient unit assessing 25 nurses’ [85% female, 8.0 ± 7.9 (mean ± SD) years’ experience in nursing] confidence in providing inhaler device education using a self-reported questionnaire, and their competency (% correct steps) in using eight different inhaler devices. Sixteen percent of participants were ‘not confident’ providing inhaler education, while 84% were ‘moderately’ or ‘extremely’ confident. The mean (±SD)% correct steps for all devices was 47 ± 17%. There was no correlation between % correct steps and nursing years (r = 0.21, p = 0.31), or ‘confidence’ with providing inhaler education (r = 0.02, p = 0.91) but % correct steps strongly correlated with number of individual device prescriptions within the hospital in the preceding year (r = 0.78, p = 0.039). Most respiratory nurses felt confident in teaching inhaler technique but their overall demonstrated ability to correctly use inhalers was poor, especially for less frequently prescribed devices within our hospital. Regular assessment and ongoing education on correct inhaler technique for respiratory nurses is necessary to optimise all device usage by nurses, irrespective of experience or confidence.

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A study on effectiveness and progress outcomes of educational inhaler technique intervention in asthma and COPD patients

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v9i2.2394 ◽

2019 ◽

Vol 9 (2) ◽

pp. 170-179

Author(s):

R Bhavana ◽

R Suchithra ◽

Manupati Thejaswini ◽

Gundlapalli Harish Kumar ◽

Dev Apoorva

Keyword(s):

Success Factors ◽

Pharmacist Intervention ◽

Inhaler Technique ◽

Face To Face ◽

Copd Patients ◽

Correct Usage ◽

Inhaler Devices ◽

Keywords Asthma

Aim: A study on effectiveness and success factors of educational inhaler technique intervention in asthma and COPD. Objectives: To identify the percentage of common errors done by people who use inhalers. To identify the risk factors associated with asthma and COPD. Method: Data was collected from the subject’s face to face interview in a community setup and the lung capacities were measured using spirometer and peak flow meter; the values were noted and the subjects were asked to demonstrate their inhaler technique using placebo inhalers; numbers of correct and incorrect steps were noted. After a period of one month; the subjects were taken to follow up and measured the lung capacities and checked the inhaler steps; number of correct and incorrect steps were noted. Results: A total of 572 samples were collected and 500 were followed up, in which 300 had Asthma and 200 had COPD. Out of which 189 were female and 311 were male. Low education level was the single most important factor leading to incorrect technique. Formal training resulted in a statistically significant increase in the percentage of correct techniques for all the devices. For pMDI (54.01% vs. 91.03%, *p=0.005 before & after training respectively). For pMDI+Spacer (52.75% vs. 94.85%, *p=0.007 before & after training respectively). For Accuhaler (54.07% vs. 91.27%, *p=0.017 before & after training respectively). For Rotahaler (63.94 vs. 98.64%. *p=0.029 before & after training respectively). For Nebuliser (56.97% vs. 91.88%, *p=0.001 before & after training respectively. Conclusion: Proper education to patients on correct usage may not only improve control of the symptoms of the disease but might also allow dose reduction in long term. The number of subjects doing correct steps gradually increased after the pharmacist led intervention. Thus, proper counselling for the inhaler use in patients must be encouraged as it is directly linked to the quality of life of patient. Keywords: Asthma and COPD control inhaler devices, inhaler technique, pharmacist intervention, inhaler education.

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General Practitioner Use of Generically Substitutable Inhaler Devices and the Impact of Training on Device Mastery and Maintenance of Correct Inhaler Technique

Pulmonary Therapy ◽

10.1007/s41030-020-00131-8 ◽

2020 ◽

Vol 6 (2) ◽

pp. 315-331

Author(s):

Biljana Cvetkovski ◽

Charlotte Hespe ◽

Rachel Tan ◽

Vicky Kritikos ◽

Elizabeth Azzi ◽

...

Keyword(s):

Generic Substitution ◽

Instructional Video ◽

Inhaler Technique ◽

Dry Powder ◽

Paired Data ◽

Significant Difference ◽

Level 3 ◽

Level 1 ◽

Level Of Training ◽

Inhaler Devices

Abstract Introduction Generic substitution of inhaler devices is a relatively new phenomenon. The best patient outcomes associated with generic substitution occur when prescribers obtain consent from their patients to prescribe a generic inhaler and also teach their patient how to correctly use the new device. To date, no prospective observational study has assessed the level of training required for general practitioners (GPs) to demonstrate correct inhaler technique using two dry powder inhaler devices delivering fixed-dose combination budesonide/formoterol therapy. This study aims to (1) determine the level of training required for GPs to master and maintain correct IT when using two different dry powder inhalers that are able to be substituted in clinical practice and (2) determine the number and types of errors made by GPs on each device and inhaler device preference at each training visit. Method A randomized, parallel-group cross-over study design was used to compare the inhaler technique of participants with a Spiromax® placebo device and a Turbuhaler® placebo device. This study consisted of two visits with each participant over a period of 4 ± 1 weeks (visit 1 and visit 2). A total of six levels of assessment and five levels of training were implemented as required. Level 1, no instruction; level 2, following use of written instruction; level 3, following viewing of instructional video; level 4, expert tuition from the researcher; level 5/level 6, repeats of expert tuition from the researcher when required. Participants progressed through each level and stopped at the point at which they demonstrated device mastery. At each level, trained researchers assessed the inhaler technique of the participants. Participants were also surveyed about their previous inhaler use and training. Results In total, 228 GPs participated in this study by demonstrating their ability to use a Turbuhaler® and a Spiromax® device. There was no significant difference between the proportion of participants who demonstrated device mastery with the Turbuhaler® compared with the Spiromax® at level 1, (no instruction), (119/228 (52%) versus 131/228 (57%), respectively, n = 228, p = 0.323 (McNemar’s test of paired data). All but one participant had demonstrated correct inhaler technique for both devices by level 3(instructional video). There was a significant difference between the proportion of participants who demonstrated maintenance of device mastery with the Turbuhaler® compared with the Spiromax® at visit 2, level 1 (127/177 (72%) versus 151/177 (85%) respectively, p = 0.003; McNemar’s test of paired data). All but two participants achieved device mastery by level 3, visit 2. More participants reported previous training with the Turbuhaler® than with Spiromax®. Discussion This study demonstrates that GPs are able to equally demonstrate correct use of the Turbuhaler® and Spiromax® devices, even though most had not received training on a Spiromax® device prior to this study. The significance of being able to demonstrate correct technique on these two devices equally has ramifications on practice and supported generic substitution of inhaler devices at the point of prescribing, as the most impactful measure a GP can take to ensure effective use of inhaled medicine is the correct demonstration of inhaler technique.

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

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-021-00218-y ◽

2021 ◽

Vol 31 (1) ◽

Author(s):

Johanna Sulku ◽

Kristina Bröms ◽

Marieann Högman ◽

Christer Janson ◽

Karin Lisspers ◽

...

Keyword(s):

Cross Sectional Study ◽

Chronic Obstructive ◽

Inhaler Technique ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Inhaler Device ◽

Device Model ◽

Copd Patients ◽

Critical Error ◽

Inhaler Devices

AbstractA 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.

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