Department of Internal Medicine, Division of Pulmonology and Allergy, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Republic of Korea.
Int J Chron Obstruct Pulmon Dis. 2021 Apr 19;16:1051-1059. doi: 10.2147/COPD.S303761. eCollection 2021.
Critical inhaler handling errors are associated with an increased risk of adverse outcomes in patients with chronic obstructive pulmonary disease (COPD). However, real-world data on inhaler device handling techniques and the risk factors for critical inhaler errors in the Asian population have been examined in only a few studies. We evaluated the rates and risk factors for critical inhaler errors in the COPD population in Korea.
COPD patients were prospectively enrolled from January 2018 to November 2019. An advanced practice nurse evaluated their inhaler technique. The 308 inhalers used by the 261 participants in this study included dry powder inhalers (DPIs; Turbuhaler, Breezhaler, Ellipta, Diskus, Genuair), a soft mist inhaler (SMI; Respimat), and pressurized metered dose inhalers (pMDIs).
The percentage critical errors for Turbuhaler, Breezhaler, Ellipta, Diskus, Genuair, Respimat, and pMDI usage were 60.0%, 41.0%, 27.8%, 12.5%, 44.4%, 45.5%, and 55.0%, respectively. In the multivariate analyses, female sex, short COPD duration, dissatisfaction with the inhaler (assessed by FSI-10), and moderate acute exacerbations (AEs) in the prior year were independent risk factors for any critical error in the DPI group. In the SMI group, a low education level and frequent AEs in the prior year were independent risk factors for any critical error, whereas a high COPD assessment test (CAT) score was the only risk factor in the pMDI group.
Critical inhaler errors are common among patients with COPD, regardless of their preferred inhaler device. The rates and risk factors for critical inhaler errors differed among patients using different devices. Optimal device selection considering the risk factors of inhaler misusage will improve disease control in COPD patients.
在慢性阻塞性肺疾病（COPD）患者中，严重的吸入器操作失误与不良结局风险增加相关。然而，仅有少数研究调查了亚洲人群中吸入器设备操作技术以及严重吸入器错误的危险因素。我们评估了韩国 COPD 患者中严重吸入器错误的发生率和危险因素。
2018 年 1 月至 2019 年 11 月，前瞻性招募了 COPD 患者。一名高级执业护士评估了他们的吸入器技术。在这项研究中，261 名参与者使用的 308 个吸入器包括干粉吸入器（DPI；Turbuhaler、Breezhaler、Ellipta、Diskus、Genuair）、软雾吸入器（SMI；Respimat）和压力定量吸入器（pMDI）。
Turbuhaler、Breezhaler、Ellipta、Diskus、Genuair、Respimat 和 pMDI 的严重错误率分别为 60.0%、41.0%、27.8%、12.5%、44.4%、45.5%和 55.0%。在多变量分析中，女性、COPD 病程较短、对吸入器不满意（由 FSI-10 评估）以及前一年中中度急性加重（AE）是 DPI 组发生任何严重错误的独立危险因素。在 SMI 组中，低教育水平和前一年频繁发生 AE 是发生任何严重错误的独立危险因素，而 CAT 评分高是 pMDI 组唯一的危险因素。
无论患者首选的吸入器设备如何，COPD 患者中严重的吸入器错误都很常见。不同设备的严重吸入器错误发生率和危险因素不同。考虑吸入器误用风险因素，选择最佳设备将改善 COPD 患者的疾病控制。
