Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Western Cape, South Africa.
UCT Lung Institute, University of Cape Town, Western Cape, South Africa.
Int J Chron Obstruct Pulmon Dis. 2020 Jun 2;15:1217-1224. doi: 10.2147/COPD.S249620. eCollection 2020.
Incorrect inhaler use is associated with poorer health outcomes, reduced quality of life, and higher healthcare utilisation in patients with asthma and COPD.
We performed an observational study of pressurized metered-dose inhaler technique in patients with asthma or COPD. Patients were assessed using a six-point inhaler checklist to identify common critical inhaler technique errors. An inadequate inhaler technique was defined as the presence of one or more critical errors. A multivariate logistic regression model was used to determine the odds of an inadequate inhaler technique.
During the 14-month study period, 357 patients were enrolled. At least one critical error was executed by 66.7% of participants, and 24.9% made four or more critical errors. The most common errors were failure to exhale completely prior to pMDI activation and inhalation (49.6%), failure to perform a slow, deep inhalation following device activation (48.7%), and failure to perform a breath-hold at the end of inspiration (47.3%). The risk of a critical error was higher in COPD patients (aOR 2.25, 95% CI 1.13-4.47). Prior training reduced error risk specifically when trained by a doctor (aOR 0.08, 95% CI 0.1-0.57) or a pharmacist (aOR 0.02, 95% CI 0.01-0.26) compared to those with no training. Previous clinical trial participation significantly reduced error risk and rate: <3 trials (aOR 0.35, 95% CI 0.19-0.66) and ≥3 trials (aOR 0.17, 95% CI 0.07-0.42). The rate of critical errors was not significantly associated with age, sex, or prior pMDI experience.
This study found a high rate of critical inhaler technique errors in a mixed population of asthma and COPD patients; however, prior training and, in particular, multiple previous clinical trial participation significantly reduced the risk of errors.
在哮喘和 COPD 患者中，不正确的吸入器使用与较差的健康结果、生活质量降低和更高的医疗保健利用相关。
我们对哮喘或 COPD 患者的压力定量吸入器技术进行了观察性研究。使用六点吸入器检查表评估患者，以确定常见的关键吸入器技术错误。定义不适当的吸入器技术为存在一个或多个关键错误。使用多变量逻辑回归模型确定不适当的吸入器技术的可能性。
在 14 个月的研究期间，共纳入 357 名患者。66.7%的参与者至少执行了一个关键错误，24.9%的患者犯了四个或更多的关键错误。最常见的错误是在 pMDI 激活和吸入前未能完全呼气（49.6%）、在装置激活后未能进行缓慢、深呼吸（48.7%）以及未能在吸气结束时屏住呼吸（47.3%）。COPD 患者发生关键错误的风险更高（比值比 2.25，95%置信区间 1.13-4.47）。先前的培训可降低错误风险，特别是在接受医生（比值比 0.08，95%置信区间 0.1-0.57）或药剂师（比值比 0.02，95%置信区间 0.01-0.26）培训时，而未接受培训的风险较高。以前参加临床试验显著降低了错误风险和发生率：<3 次试验（比值比 0.35，95%置信区间 0.19-0.66）和≥3 次试验（比值比 0.17，95%置信区间 0.07-0.42）。关键错误的发生率与年龄、性别或以前的 pMDI 经验无显著相关性。
本研究在哮喘和 COPD 混合人群中发现了高比例的关键吸入器技术错误；然而，先前的培训，特别是多次参加临床试验，显著降低了错误风险。
