COPD: misuse of inhaler devices in clinical practice

• Published in: International journal of chronic obstructive pulmonary disease 2019-01, Vol.14, p.1209-1217
• Main Authors: Araújo, António Duarte, Teixeira, Pedro Miguel Silva Costa Afonso, Hespanhol, Venceslau, Correia de Sousa, Jaime
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adult; Age Factors; Aged; Ambulatory Care; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - adverse effects; Checklist; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; COPD; Cross-Sectional Studies; Educational Status; Elderly; Elderly patients; Equipment Design; Female; Health Knowledge, Attitudes, Practice; Humans; Inhalation technique; Inhaler device; Inhaler devices; Inhalers; Inhalers misuse; Lung - drug effects; Lung - physiopathology; Male; Medical research; Middle Aged; Nebulizers and Vaporizers; Original Research; Patient Education as Topic; Patient Preference; Patients; Patients’ beliefs; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Questionnaires; Respiratory system agents; Science & Technology; Sex Factors; Social class; Statistical analysis
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S178040

Background and objectives: Inhalers mishandling remain an important clinical issue worldwide. The aim of this study was to evaluate inhalation technique in stable COPD out-patients. The variables under study were type of inhaler device (ID), patients' preference for an inhaler, number of IDs used by each patient, beliefs about inhaler medication and some demographic, clinical and functional patients' characteristics. We aim to assess how they are related to inhalation technique. Methods: A cross-sectional study was conducted in a hospital outpatient respiratory care. COPD patients over 40 years old, diagnosed according to GOLD criteria, and using IDs were included consecutively. The Beliefs about Medicines Questionnaire (BMQ), a demographic and a clinical survey were applied. The number of IDs used by each patient and the patients' preference for some IDs were recorded. Patients were asked to demonstrate the use of their prescribed inhalation devices, and inhaler technique was assessed by using previously defined checklists, including essential steps and critical errors. A statistics analysis was then performed. Results: We studied 300 subjects performing a total of 521 inhalation manoeuvers with 10 different IDs. At least one step incorrectly performed was found in 48.2% of demonstrations and in 29.9% critical errors were observed. Misuse was related to priming/loading in 6.9%, to inhalation manoeuver in 13.1% and to both in 10%. There was a statistically significant association between critical errors and type of ID (P