Rajah Retha, Tang Yi Woei, Ho Shien Chee, Tan Jo Lyn, Mat Said Muhamad Shuhaimi, Ooi Lee Hwang
Hospital Seberang Jaya, Seberang Jaya, Malaysia.
Hospital Pulau Pinang, Georgetown, Pulau Pinang, Malaysia.
Hosp Pharm. 2022 Apr;57(2):217-222. doi: 10.1177/00185787211010164. Epub 2021 Apr 21.
Inhaler technique errors can affect the disease outcome through reduced deposition of medication in the lungs with certain errors were more likely to deter the optimum drug from reaching the lung. The objective of this study was to evaluate the pressurized metered-dose inhaler (pMDI) critical technique errors among asthma and COPD patients, and to investigate the predictors of those errors. A cross-sectional, observational, and multi-centered study conducted in 3 major hospitals in the state of Penang, Malaysia. Asthma and COPD patients aged 18 years or older consented to the study were consecutively recruited if they were at least on 1 pMDI without mouthpiece spacer or facemask space. Direct observation of the patient's technique was recorded using a standard checklist and certain steps in the checklist were pre-determined as critical steps. The number of patients missed or incorrectly performed the steps including the critical steps were documented. Using logistic regression, the factors associated with the critical errors were determined, and the correlation was evaluated between age and pMDI knowledge score with critical inhalation steps score. Of 209 patients observed, only less than half (40.7%) could perform all the critical pMDI steps correctly. Low education level was the only factor associated with critical inhaler errors. The increased knowledge of their inhaled medication was found to positively correlate with the correct critical inhalation steps. The critical errors also increase with the increased age of patients. The majority of the study population make inhalation error particularly in critical steps. Training and education intervention programs may help patients with lower education level, as well as those of advanced age and lack of knowledge of their inhaled medication because those populations are at a greater risk of committing critical errors in their use of pMDI.
吸入器技术错误可通过减少药物在肺部的沉积来影响疾病转归，某些错误更有可能阻碍最佳药物抵达肺部。本研究的目的是评估哮喘和慢性阻塞性肺疾病（COPD）患者中压力定量吸入器（pMDI）的关键技术错误，并探究这些错误的预测因素。在马来西亚槟城州的3家主要医院开展了一项横断面、观察性的多中心研究。年龄在18岁及以上、同意参与研究的哮喘和COPD患者，如果他们至少使用1种不带储雾罐或面罩的pMDI，则被连续纳入研究。使用标准检查表记录对患者技术的直接观察情况，检查表中的某些步骤被预先确定为关键步骤。记录患者遗漏或错误执行步骤（包括关键步骤）的数量。使用逻辑回归确定与关键错误相关的因素，并评估年龄和pMDI知识得分与关键吸入步骤得分之间的相关性。在观察的209例患者中，只有不到一半（40.7%）能够正确执行所有关键的pMDI步骤。低教育水平是与关键吸入器错误相关的唯一因素。发现患者对吸入药物了解的增加与正确的关键吸入步骤呈正相关。关键错误也随着患者年龄的增加而增加。大多数研究人群存在吸入错误，尤其是在关键步骤。培训和教育干预项目可能有助于教育水平较低的患者，以及高龄和对吸入药物缺乏了解的患者，因为这些人群在使用pMDI时出现关键错误的风险更大。
