Department of Pharmacy, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People's Republic of China.
Department of Pharmacy, Changhai Hospital Affiliated to The Second Military Medical University, Shanghai 200433, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2020 Jun 22;15:1471-1479. doi: 10.2147/COPD.S253338. eCollection 2020.
Proper inhaler technique is highly relevant to the effective management of chronic obstructive pulmonary disease (COPD). The tiotropium bromide spray (TBS) (Spiriva Respimat) is a soft mist inhaler (SMI) preferred by patients to pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) because of its convenience in use. However, the technique of using TBS inhaler in the real world is unclear.
To evaluate techniques in using TBS inhaler and investigate the association between the patient characteristics and the correct use of TBS inhaler.
This cross-sectional study enrolled 74 COPD patients who used TBS inhaler device for more than 3 months. The sociodemographic and clinical characteristics of the patients were recorded. The technique of using TBS inhaler was evaluated step by step. Incorrect use was defined as the patient's inability to complete the key steps in the inhalation manoeuvre. The percentage of incorrect use was compared between the groups. Risk factors related to incorrect use were analyzed by logistic regression analysis.
Of the 74 participants, only 2 (2.7%) patients completed all the steps correctly, and 48 (64.9%) patients misused the key steps in the inhalation manoeuvre. Incorrect preparation of the TBS inhaler for the first use was the most frequently misused step, accounting for 77.0%. Factors associated with misuse of TBS inhaler included the educational background (p=0.010), living state (p=0.031) and COPD assessment test (CAT) score (p=0.005) of the patients. Additionally, logistic regression analysis showed that the COPD duration was significantly associated with the incorrect use (p=0.019). Compared with patients with a higher educational background, patients with an elementary school background [OR 11652.99, CI: 22.72-5975697.72], junior high school background [OR 7187.78, CI: 16.41-3146787] and high school background [OR 1563, CI: 4.27-572329.67] were more likely to misuse TBS inhaler. Patients living with their spouses alone were also more likely to commit errors in using TBS inhaler as compared with those living with their children [OR 12.29, CI of 1.14-1.96]. Clinical factors like the COPD symptoms were relative to the technical use of the device. Better technique was accompanied by a lower CAT score [OR 1.49, CI of 1.14-1.96].
The incorrect use of TBS inhaler was common in COPD patients. Healthcare providers should not only teach the patients about the drug preparation but help them use the inhaler correctly. Special attention should be paid to patients with a short COPD duration and a low educational background and those who live without the company of their children. Proper use of TBS inhaler can significantly improve the symptom control of COPD patients.
正确的吸入器技术对于慢性阻塞性肺疾病（COPD）的有效管理非常重要。噻托溴铵喷雾剂（TBS）（Spiriva Respimat）是一种软雾吸入器（SMI），由于其使用方便，优于压力定量吸入器（pMDI）和干粉吸入器（DPI），因此深受患者喜爱。然而，在现实世界中，TBS 吸入器的使用技术尚不清楚。
评估 TBS 吸入器的使用技术，并研究患者特征与 TBS 吸入器正确使用之间的关系。
本横断面研究纳入了 74 名使用 TBS 吸入器装置超过 3 个月的 COPD 患者。记录患者的社会人口统计学和临床特征。逐步评估 TBS 吸入器的使用技术。将无法完成吸入操作关键步骤的患者定义为使用不当。比较各组之间不正确使用的百分比。通过 logistic 回归分析分析与不正确使用相关的危险因素。
74 名参与者中，仅有 2 名（2.7%）患者正确完成了所有步骤，48 名（64.9%）患者在吸入操作的关键步骤中使用不当。TBS 吸入器首次使用时不正确的准备是最常被误用的步骤，占 77.0%。与 TBS 吸入器使用不当相关的因素包括患者的教育背景（p=0.010）、生活状态（p=0.031）和 COPD 评估测试（CAT）评分（p=0.005）。此外，logistic 回归分析表明，COPD 持续时间与不正确使用显著相关（p=0.019）。与具有较高教育背景的患者相比，具有小学背景的患者[OR 11652.99，CI：22.72-5975697.72]、初中背景的患者[OR 7187.78，CI：16.41-3146787]和高中背景的患者[OR 1563，CI：4.27-572329.67]更有可能错误使用 TBS 吸入器。与与子女同住的患者相比，与配偶单独居住的患者在使用 TBS 吸入器时也更容易出现错误[OR 12.29，CI：1.14-1.96]。临床因素如 COPD 症状与设备的技术使用有关。更好的技术伴随着较低的 CAT 评分[OR 1.49，CI：1.14-1.96]。
COPD 患者中 TBS 吸入器的不正确使用很常见。医疗保健提供者不仅应教授患者药物准备知识，还应帮助他们正确使用吸入器。应特别关注 COPD 持续时间较短、教育程度较低且无子女陪伴的患者。正确使用 TBS 吸入器可显著改善 COPD 患者的症状控制。
