Academic Primary Care, University of Aberdeen, Aberdeen; Observational and Pragmatic Research Institute Pte Ltd, Singapore.
Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Palma (IdisPa), Palma de Mallorca.
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.
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.
The CRITical Inhaler mistaKes and Asthma controL study investigated the association between specific inhaler errors and asthma outcomes.
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.
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.
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.
较差的吸入器技术与较差的哮喘结果相关。培训可以减少吸入器错误的数量，但尚不清楚哪些错误对哮喘结果的影响最大。
CRITical 吸入器错误和哮喘控制研究调查了特定吸入器错误与哮喘结果之间的关系。
本分析使用了来自 iHARP 哮喘审查服务的数据-一项针对哮喘成年人的多中心横断面研究。审查于 2011 年至 2014 年进行，从 5000 多名患者那里捕获了人口统计学特征、哮喘症状和由经过专门培训的医疗保健专业人员观察到的吸入器错误的数据。接受吸入皮质类固醇和长效β激动剂固定剂量联合治疗的哮喘患者根据其使用的控制器吸入器装置（干粉吸入器或计量吸入器）进行分类：在设备队列内分析错误频率、哮喘症状控制和加重率，以确定关键错误。
本报告包含 3660 名患者的数据。吸气力度不足很常见（干粉吸入器使用者中有 32%-38%存在这种情况），与哮喘未控制相关（使用 Turbohaler 和 Diskus 装置的患者分别为调整后的优势比[95%CI]，1.30[1.08-1.57]和 1.56[1.17-2.07]）和加重率增加。在计量吸入器使用者中，在吸入前启动（24.9%的患者）与哮喘未控制相关（1.55[1.11-2.16]）。还确定了其他一些更通用和特定设备的错误作为关键错误。
特定的吸入器错误已被确定为关键错误，这一点从其频率和与哮喘结果的关联得到证明。哮喘管理应针对吸入器培训，以减少关键关键错误。
