University of Chicago Biological Sciences Division, Departments of Medicine and Pediatrics , Chicago, IL, USA.
Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy , Asheville, NC, USA.
Expert Rev Respir Med. 2020 Aug;14(8):791-805. doi: 10.1080/17476348.2020.1754800. Epub 2020 Apr 28.
Respiratory inhalers, when used correctly, provide critical treatments for managing pulmonary conditions. However, many patients misuse inhalers, negatively affecting disease control, quality of life, healthcare utilization, and costs. Numerous factors are associated with misuse and are nested within four levels of influence: individual, interpersonal, organizational/institutional, and policy.
This review analyzed published literature and identified the most salient factors at each socio-ecological framework level. English language articles from any year were identified from PubMed, Google Scholar, and Embase databases. Misuse exists across clinical settings, patient populations, and device types. Several potential solutions are highlighted. Published interventions to improve inhaler technique have utilized handouts, in-person, virtual, and biofeedback approaches both inside and outside of healthcare settings with varied effectiveness. However, some interventions have superior effectiveness for improving technique and reducing acute care utilization.
To robustly address inhaler misuse, future solutions should focus on multi-level approaches to account for the myriad of factors contributing to inhaler misuse. Solutions should also streamline inhaler equipment, identify innovative technology-based solutions, support collaborations across healthcare and non-healthcare settings, and ensure reimbursement to healthcare professionals for inhaler education. Rigorous research studies must be funded and supported to identify and disseminate solutions.
呼吸吸入器在正确使用时，可为管理肺部疾病提供关键治疗。然而，许多患者错误使用吸入器，从而对疾病控制、生活质量、医疗保健利用和成本产生负面影响。许多因素与误用有关，并嵌套在四个影响层面：个人、人际、组织/机构和政策。
这篇综述分析了已发表的文献，并确定了每个社会生态学框架层面上最突出的因素。从 PubMed、Google Scholar 和 Embase 数据库中确定了任何年份的英文文章。误用现象存在于各种临床环境、患者群体和设备类型中。强调了一些潜在的解决方案。为了改善吸入器技术，已发表的干预措施在医疗保健环境内外都使用了手册、面对面、虚拟和生物反馈方法，效果各不相同。然而，一些干预措施在改善技术和减少急性护理利用方面具有更高的效果。
为了有效解决吸入器误用问题，未来的解决方案应重点关注多层面方法，以解决导致吸入器误用的众多因素。解决方案还应简化吸入器设备，确定创新的基于技术的解决方案，支持医疗保健和非医疗保健环境之间的合作，并确保为医疗保健专业人员的吸入器教育提供报销。必须为有针对性的研究提供资金和支持，以确定和传播解决方案。
