Department of Pulmonology, Academic Medical Centre, Amsterdam, The Netherlands.
J Aerosol Med Pulm Drug Deliv. 2010 Oct;23(5):323-8. doi: 10.1089/jamp.2009.0785.
Inadequate technique reduces the effects of inhalation medication. Errors in inhalation technique have been reported to range up to 85%. Not only various patients' characteristics but also the device has an effect on correct inhalation technique. The purpose of this study was to determine the effect of patients' characteristics and type of inhaler device on inhalation technique in patient with asthma or chronic obstructive pulmonary disease (COPD).
A validated scoring method was used that consisted of triple viewing of video-recorded inhalations, using device-specific checklists. The following patient characteristics were investigated: gender, age, education level, diagnosis, treatment by a pulmonary physician, previously received inhalation instruction, exacerbation frequency, knowledge, self-management competence, pulmonary function, and use of multiple inhaler devices. Chi-square statistics were used for univariate associations between potential determinants and correctness of inhalation technique. Relevant determinants were entered into a multivariate logistic regression model. Moreover, inhalation technique errors were examined for six inhaler devices: three prefilled dry powder inhalers, one single-dose dry powder inhaler, a pressurized metered-dose inhaler (pMDI) and a pMDI with a spacer.
Overall, 40% of the patients made at least one essential mistake in their inhalation technique. Patients who never received inhalation instruction and patients who used more than one inhaler device made significantly more errors (odds ratio both 2.2). Comparison between devices showed that a correct inhalation technique most likely occurred with the use of prefilled dry powder devices.
Incorrect inhalation technique is common among asthma and COPD patients in a pulmonary outpatient clinic. Our study suggests that the use of prefilled dry powder inhalers as well as inhalation instruction increases correct inhalation technique. Simultaneous use of different types of inhalation devices has to be discouraged.
吸入药物技术不当会降低疗效。据报道，吸入技术错误的发生率高达 85%。不仅各种患者特征，而且吸入装置也会影响正确的吸入技术。本研究旨在确定患者特征和吸入器类型对哮喘或慢性阻塞性肺疾病（COPD）患者吸入技术的影响。
使用经过验证的评分方法，对视频记录的吸入过程进行三重观察，并使用特定设备的检查表。研究了以下患者特征：性别、年龄、教育水平、诊断、是否接受过肺病医生的治疗、是否接受过吸入指导、发作频率、知识、自我管理能力、肺功能以及使用多种吸入器。使用卡方检验对潜在决定因素与吸入技术正确性之间的关系进行单变量关联分析。将相关决定因素纳入多变量逻辑回归模型。此外，还检查了六种吸入器的吸入技术错误：三种预充式干粉吸入器、一种单剂量干粉吸入器、一种压力定量气雾剂（pMDI）和一种带喷雾器的 pMDI。
总体而言，40%的患者在吸入技术中至少犯了一个关键错误。从未接受过吸入指导的患者和使用超过一种吸入器的患者犯的错误明显更多（比值比均为 2.2）。不同装置之间的比较表明，正确的吸入技术最可能发生在使用预充式干粉装置时。
在肺门诊的哮喘和 COPD 患者中，不正确的吸入技术很常见。我们的研究表明，使用预充式干粉吸入器和吸入指导可以提高正确的吸入技术。同时使用不同类型的吸入装置必须受到限制。
