Collier David J, Wielders Pascal, van der Palen Job, Heyes Logan, Midwinter Dawn, Collison Kathryn, Preece Andy, Barnes Neil, Sharma Raj
William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
Int J Chron Obstruct Pulmon Dis. 2020 Jun 9;15:1301-1313. doi: 10.2147/COPD.S224209. eCollection 2020.
Training in correct inhaler use, ideally in person or by video demonstration, can minimize errors but is rarely provided in clinics. This open-label, low-intervention study evaluated critical error rates with dry-powder inhalers (DPIs), before and after training, in patients with chronic obstructive pulmonary disease.
Patients prescribed an inhaled corticosteroid (ICS)/long-acting β-agonist (LABA) (ELLIPTA, Turbuhaler, or DISKUS), long-acting muscarinic antagonist (LAMA)/LABA (ELLIPTA or Breezhaler), or LAMA-only DPI (ELLIPTA, HandiHaler, or Breezhaler) were enrolled. Critical errors were assessed before training (Visit 1 [V1]; primary endpoint) and 6 weeks thereafter (Visit 2 [V2]; secondary endpoint). Logistic regression models were used to calculate odds ratios (ORs) for between-group comparisons.
The intent-to-treat population comprised 450 patients. At V1, fewer patients made ≥1 critical error with ELLIPTA (10%) versus other ICS/LABA DPIs (Turbuhaler: 40%, OR 4.66, =0.005; DISKUS: 26%, OR 2.48, =0.114) and other LAMA or LAMA/LABA DPIs (HandiHaler: 34%, OR 3.50, =0.026; Breezhaler: 33%, OR 3.94, =0.012). Critical error rates with the primary ICS/LABA DPI were not significantly different between ELLIPTA ICS/LABA (10%) and ICS/LABA plus LAMA groups (12-25%). Critical errors with the primary ICS/LABA DPI occurred less frequently with ELLIPTA ICS/LABA with or without LAMA (11%) versus Turbuhaler ICS/LABA with or without LAMA (39%, OR 3.99, <0.001) and DISKUS ICS/LABA with or without LAMA (26%, OR 2.18, =0.069). Simulating single-inhaler versus multiple-inhaler triple therapy, critical error rates were lower with ELLIPTA fluticasone furoate/vilanterol (FF/VI; 10%) versus ELLIPTA FF/VI plus LAMA (22%), considering errors with either DPI (OR 2.50, =0.108). At V2, critical error rates decreased for all DPIs/groups, reaching zero only for ELLIPTA. Between-group comparisons were similar to V1.
Fewer patients made critical errors with ELLIPTA versus other ICS/LABA, and LAMA or LAMA/LABA DPIs. The effect of "verbal" training highlights its importance for reducing critical errors with common DPIs.
正确使用吸入器的培训，理想情况下是亲自培训或通过视频演示，可将错误降至最低，但在诊所中很少提供。这项开放标签、低干预研究评估了慢性阻塞性肺疾病患者在使用干粉吸入器（DPI）时，培训前后的严重错误率。
纳入了处方吸入性糖皮质激素（ICS）/长效β受体激动剂（LABA）（易纳器、都保或准纳器）、长效毒蕈碱拮抗剂（LAMA）/LABA（易纳器或布地奈德吸入粉雾剂）或仅使用LAMA的DPI（易纳器、HandiHaler或布地奈德吸入粉雾剂）的患者。在培训前（第1次就诊[V1]；主要终点）和此后6周（第2次就诊[V2]；次要终点）评估严重错误。使用逻辑回归模型计算组间比较的优势比（OR）。
意向性治疗人群包括450名患者。在V1时，与其他ICS/LABA DPI（都保：40%，OR 4.66，P = 0.005；准纳器：26%，OR 2.48，P = 0.114）以及其他LAMA或LAMA/LABA DPI（HandiHaler：34%，OR 3.50，P = 0.026；布地奈德吸入粉雾剂：33%，OR 3.94，P = 0.012）相比，使用易纳器的患者出现≥1次严重错误的人数较少。主要ICS/LABA DPI的严重错误率在易纳器ICS/LABA（10%）和ICS/LABA加LAMA组（12 - 25%）之间无显著差异。无论有无LAMA，与都保ICS/LABA（39%，OR 3.99，P < 0.001）和准纳器ICS/LABA（26%，OR 2.18，P = 0.069）相比，易纳器ICS/LABA的主要ICS/LABA DPI出现严重错误的频率较低。模拟单吸入器与多吸入器三联疗法，考虑两种DPI的错误情况，与易纳器糠酸氟替卡松/维兰特罗（FF/VI；10%）相比，易纳器FF/VI加LAMA（22%）的严重错误率较低（OR 2.50，P = 0.108）。在V2时，所有DPI/组的严重错误率均下降，仅易纳器的严重错误率降至零。组间比较与V1相似。
与其他ICS/LABA、LAMA或LAMA/LABA DPI相比，使用易纳器出现严重错误的患者较少。“口头”培训的效果凸显了其对于减少常见DPI严重错误的重要性。
