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J Asthma. 2016;53(3):321-9. doi: 10.3109/02770903.2015.1099160. Epub 2016 Jan 26.

Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting.

Author information

1
a Research in Real-Life, Ltd , Cambridge , United Kingdom .
2
b Optimum Patient Care Ltd , Cambridge , United Kingdom .
3
c Inhalation Consultancy, Ltd , Yeadon , Leeds , United Kingdom .
4
d Woodbrook Medical Centre, Loughborough, United Kingdom, Centre for Population Health Sciences, University of Edinburgh , United Kingdom .
5
e Box Surgery , Box , United Kingdom .
6
f Academic Primary Care, University of Aberdeen , Aberdeen , United Kingdom .
7
g University Paris Descartes (EA2511), Cochin Hospital Group (AP-HP) , Paris , France .
8
h Department of Experimental and Clinical Medicine , Careggi University Hospital , Florence , Italy .
9
i Department of Medical Sciences , University of Ferrara , Ferrara , Italy .
10
j Special Interest Respiratory Area, Società Italiana Interdisciplinare per le Cure Primarie , Bari , Italy .
11
k Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Palma IdisPa , Palma de Mallorca , Spain .
12
l Sydney Medical School and the Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia .
13
m Department of Public Health and Caring Sciences , Preventive Medicine and Family Medicine, Uppsala University , Uppsala , Sweden .
14
n Department of General Medicine , University of Oslo and Langbølgen Legesenter , and.
15
o Department of Primary Care , University of Groningen, University Medical Centre Groningen , Groningen , The Netherlands.

Abstract

OBJECTIVE:

Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI).

METHODS:

This was a historical, multinational, cross-sectional study (2011-2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with ≥1 serious errors.

RESULTS:

Of 3681 patients with asthma, 623 (17%) were using a Diskus (mean [SD] age, 51 [14]; 61% women). A total of 341 (55%) patients made ≥1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with ≥1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.26-3.40); obesity (OR 1.75; 1.17-2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04-2.36); female sex (OR 1.51; 1.08-2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04-2.02).

CONCLUSIONS:

Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate.

KEYWORDS:

Asthma therapy; Diskus inhaler; cross-sectional; inhalation devices; multinational

PMID:
26810934
PMCID:
PMC4819842
DOI:
10.3109/02770903.2015.1099160
[Indexed for MEDLINE]
Free PMC Article

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