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J Allergy Clin Immunol Pract. 2017 Jul - Aug;5(4):1071-1081.e9. doi: 10.1016/j.jaip.2017.01.004. Epub 2017 Mar 9.

Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes.

Author information

1
Academic Primary Care, University of Aberdeen, Aberdeen; Observational and Pragmatic Research Institute Pte Ltd, Singapore. Electronic address: dprice@opri.sg.
2
Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Palma (IdisPa), Palma de Mallorca.
3
Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colo.
4
Woolcock Institute of Medical Research, University of Sydney, Sydney; Sydney Local Health District, Sydney.
5
Optimum Patient Care, Cambridge.
6
General Practitioner, Box Surgery, Box.
7
Academic Primary Care, University of Aberdeen, Aberdeen.
8
General Practitioner, Langbølgen Legesenter, Oslo.
9
Observational and Pragmatic Research Institute Pte Ltd, Singapore.
10
Special Interest Respiratory Area, Italian Interdisciplinary Society for Primary Care, Bari.
11
Department of Experimental and Clinical Medicine, University of Florence, Florence.
12
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala.
13
Department of Medical Sciences, University of Ferrara, Ferrara.
14
Optimum Patient Care, Cambridge; Centre for Population Health Sciences, University of Edinburgh, Edinburgh.
15
Department of Primary Care, University of Groningen, University Medical Centre Groningen, Groningen.
16
Observational and Pragmatic Research Institute Pte Ltd, Singapore; Faculty of Health and Human Sciences, Plymouth University, Peninsula Allied Health Centre, Derriford Road, Plymouth.

Abstract

BACKGROUND:

Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes.

OBJECTIVE:

The CRITical Inhaler mistaKes and Asthma controL study investigated the association between specific inhaler errors and asthma outcomes.

METHODS:

This analysis used data from the iHARP asthma review service-a multicenter cross-sectional study of adults with asthma. The review took place between 2011 and 2014 and captured data from more than 5000 patients on demographic characteristics, asthma symptoms, and inhaler errors observed by purposefully trained health care professionals. People with asthma receiving a fixed-dose combination treatment with inhaled corticosteroids and long-acting beta agonist were categorized by the controller inhaler device they used-dry-powder inhalers or metered-dose inhalers: inhaler errors were analyzed within device cohorts. Error frequency, asthma symptom control, and exacerbation rate were analyzed to identify critical errors.

RESULTS:

This report contains data from 3660 patients. Insufficient inspiratory effort was common (made by 32%-38% of dry-powder inhaler users) and was associated with uncontrolled asthma (adjusted odds ratios [95% CI], 1.30 [1.08-1.57] and 1.56 [1.17-2.07] in those using Turbohaler and Diskus devices, respectively) and increased exacerbation rate. In metered-dose inhaler users, actuation before inhalation (24.9% of patients) was associated with uncontrolled asthma (1.55 [1.11-2.16]). Several more generic and device-specific errors were also identified as critical.

CONCLUSIONS:

Specific inhaler errors have been identified as critical errors, evidenced by frequency and association with asthma outcomes. Asthma management should target inhaler training to reduce key critical errors.

KEYWORDS:

Asthma control; Exacerbation; Inhaler errors; Inhaler technique

PMID:
28286157
DOI:
10.1016/j.jaip.2017.01.004
[Indexed for MEDLINE]

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