Batterink Joshua, Dahri Karen, Aulakh Amneet, Rempel Carmen
, BSc(Pharm), ACPR, is a Clinical Pharmacist with Providence Health Care, St Paul's Hospital, Vancouver, British Columbia.
Can J Hosp Pharm. 2012 Mar;65(2):111-8. doi: 10.4212/cjhp.v65i2.1118.
The prevalence of chronic obstructive pulmonary disease (COPD) is increasing. Patients with COPD are treated with a variety of inhaled medications. Previous studies evaluating inhaler technique have had varied results but have generally found high rates of misuse of these devices. There is a paucity of studies of inhaler technique focusing on North American patients with COPD who have been admitted to hospital.
To evaluate the inhaler technique of patients with COPD who have been admitted to hospital and to identify baseline patient characteristics and/or inhaler devices associated with poor inhaler technique.
Patients with a diagnosis of COPD who were admitted to the hospitalist or internal medicine service at a tertiary care hospital in British Columbia between October 2010 and April 2011 were identified. After giving informed consent, recruited patients demonstrated their inhaler technique, which was evaluated with standardized checklists. Errors in technique were categorized as either noncritical or critical. Critical errors were defined as those resulting in little or no medication reaching the lungs.
Thirty-seven patients (mean age 78 years) participated in the study. Twenty-two (59%) of the patients made critical errors while demonstrating their inhaler technique. Patients using metered-dose inhalers were more likely to make a critical error than patients using other inhalers (13/14 [93%] versus 9/23 [39%]; relative risk 2.38, p = 0.002). On average, 26% of the steps for using an inhaler were performed incorrectly. Twenty-three (62%) of the patients reported having received previous counselling on inhaler technique, but only 13 (57%) of these 23 patients had received such counselling in the previous 6 months.
More than half of the patients in this study misused their inhaler devices, and many made critical errors that would result in inadequate amounts of drug reaching the lung. Many of the patients were not receiving regular counselling on appropriate inhaler technique. Health care professionals should be aware of poor inhaler technique, should routinely evaluate their patients' inhaler technique, and should provide counselling.
慢性阻塞性肺疾病（COPD）的患病率正在上升。COPD患者接受多种吸入药物治疗。以往评估吸入器使用技术的研究结果各异，但普遍发现这些装置的误用率很高。针对北美住院的COPD患者进行的吸入器使用技术研究较少。
评估住院的COPD患者的吸入器使用技术，并确定与吸入器使用技术不佳相关的患者基线特征和/或吸入器装置。
确定2010年10月至2011年4月期间在不列颠哥伦比亚省一家三级护理医院入住内科或内科病房且诊断为COPD的患者。在获得知情同意后，招募的患者展示其吸入器使用技术，并用标准化检查表进行评估。技术错误分为非严重错误或严重错误。严重错误定义为导致很少或没有药物到达肺部的错误。
37名患者（平均年龄78岁）参与了研究。22名（59%）患者在展示吸入器使用技术时出现严重错误。使用定量吸入器的患者比使用其他吸入器的患者更有可能出现严重错误（14名中的13名[9
