Chorão Pedro, Pereira Ana M, Fonseca João A
Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
CIDES - Centro de Investigação em Tecnologias e Sistemas de Informação & CINTESIS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Unidades de Imunoalergologia, CUF Porto, Porto, Portugal; Serviço de Imunoalergologia, Centro Hospitalar São João, Porto, Portugal.
Respir Med. 2014 Jul;108(7):968-75. doi: 10.1016/j.rmed.2014.04.019. Epub 2014 May 10.
Incorrect use of inhaler devices remains an obstacle for respiratory diseases management. We aimed to evaluate the frequency of inhaler technique errors; to determine the devices perceived as the easiest and favourite to use; to study the association of device type, demographics and patient preferences with inhaler technique (IT).
Cross-sectional assessment of 301 adults, with asthma (194) or chronic pulmonary obstructive disease, undergoing treatment with Aerolizer®, Autohaler®, Breezehaler®, Diskus®, Handihaler®, MDI without spacer, Miat-haler®, Novolizer®, Respimat® and/or Turbohaler®. Patients completed self-assessment questionnaires and face-to-face interview, with demonstration of inhaler technique. The rate of wrong steps (number of wrong steps ÷ number of total steps; RWS) was the primary outcome. Adjusted odds ratio (aOR) (95% confidence intervals [CI]) for presenting ≥1 IT errors were computed.
From the 464 inhaler technique performances, the median RWS was 18%. Turbohaler® (21%) and Diskus® (19%) were chosen as easiest and Novolizer® (18%), Diskus® (18%), Turbohaler® (17%) as favourite for daily use. Females (aOR 2.68 [95% CI 1.55-4.65]; vs. males], patients with >64 yr (aOR 2.73 [95% CI 1.15-6.48]; vs <45 yr) and patients using Aerolizer® or Handihaler® (aOR 3.24 [95% CI 1.13-9.32] and aOR 3.71 [95% CI 1.38-10.2], respectively) were more likely to perform IT errors; otherwise, no association was found, including with using the favourite device (aOR 1.43 [95% CI 0.84-2.42]).
The frequency of inhaler technique errors was high and no device was clearly preferred over the others. Using the preferred inhaler device was not associated with less errors.
吸入装置使用不当仍是呼吸系统疾病管理的一个障碍。我们旨在评估吸入技术错误的发生率；确定被认为最易于使用和最受欢迎的装置；研究装置类型、人口统计学特征和患者偏好与吸入技术（IT）之间的关联。
对301名患有哮喘（194例）或慢性阻塞性肺疾病的成年人进行横断面评估，这些患者正在使用艾乐雾化器、自动吸入器、微风吸入器、都保、手吸器、不带储雾罐的定量吸入器、米亚吸入器、诺沃吸入器、思力华和/或准纳器进行治疗。患者完成自我评估问卷和面对面访谈，并进行吸入技术演示。错误步骤发生率（错误步骤数÷总步骤数；RWS）是主要结果。计算出现≥1次IT错误的调整优势比（aOR）（95%置信区间[CI]）。
在464次吸入技术操作中，RWS的中位数为18%。准纳器（21%）和都保（19%）被选为最易于使用的装置，诺沃吸入器（18%）、都保（18%）、准纳器（17%）被选为日常使用中最受欢迎的装置。女性（aOR 2.68[95%CI 1.55 - 4.65]；与男性相比）、64岁以上的患者（aOR 2.73[95%CI 1.15 - 6.48]；与45岁以下患者相比）以及使用艾乐雾化器或手吸器的患者（分别为aOR 3.24[95%CI 1.13 - 9.32]和aOR 3.71[95%CI 1.38 - 10.2]）更有可能出现IT错误；否则，未发现关联，包括与使用最受欢迎的装置（aOR 1.43[95%CI 0.84 - 2.42]）。
吸入技术错误的发生率很高，没有一种装置明显优于其他装置。使用首选的吸入装置与较少的错误无关。
