Hôpital Cochin, AP-HP. Centre-Université de Paris, Paris, France.
GSK, Singapore, 139234, Singapore.
Respir Med. 2022 Oct;202:106949. doi: 10.1016/j.rmed.2022.106949. Epub 2022 Sep 2.
Many patients with asthma use their inhalers incorrectly, which can lead to sub-optimal asthma control and an increased risk of exacerbations. The Accuhaler/Diskus and Turbuhaler are arguably two of the most commonly used dry powder inhalers worldwide.
A systematic literature review (SLR) was conducted to assess the impact of inhalation errors with these dry powder inhalers on clinical outcomes in asthma. Database searches were conducted in MEDLINE, Embase and proceedings from scientific conferences. Observational studies in adults and adolescents with asthma, reporting data for Accuhaler/Diskus and Turbuhaler devices and at least one outcome of interest, were included. Dual-independent screening and validation of studies was performed.
The search identified 35 studies. A range of inhaler errors was observed across studies and devices. In 8 out of the 9 studies that involved the two devices, the percentage of overall inhaler error rates was numerically (7 studies) or significantly (1 study) higher for Turbuhaler than Diskus, ranging from 3.7% to 71.9% for Diskus and 1.2%-83% for Turbuhaler. Critical errors, reported in three studies using similar definitions, ranged from 20% to 43% for Diskus and 32%-100% for Turbuhaler. Five studies reported a significant association between inhaler errors and worse asthma control, while one showed no difference.
This SLR identified a large range of inhaler errors with both devices. Across devices, a better inhalation technique was associated with better asthma outcomes. This systematic review confirms the importance of patients using their inhalers correctly as an integral part of achieving optimal asthma outcomes.
许多哮喘患者使用吸入器的方法不正确，这可能导致哮喘控制不佳和加重发作的风险增加。Accuhaler/Diskus 和 Turbuhaler 可以说是全球使用最广泛的两种干粉吸入器。
系统文献回顾（SLR）旨在评估这些干粉吸入器的吸入错误对哮喘临床结局的影响。在 MEDLINE、Embase 和科学会议记录中进行了数据库搜索。纳入了在成人和青少年哮喘患者中进行的观察性研究，报告了 Accuhaler/Diskus 和 Turbuhaler 装置的数据以及至少一个感兴趣的结局。对研究进行了双重独立筛选和验证。
搜索共确定了 35 项研究。在各项研究和装置中均观察到了各种吸入器错误。在涉及这两种装置的 9 项研究中的 8 项中，Turbuhaler 的整体吸入器错误率数值上（7 项研究）或显著更高（1 项研究），Accuhaler 的错误率范围为 Diskus 的 3.7%至 71.9%，Turbuhaler 的错误率为 1.2%至 83%。使用类似定义的三项研究报告了关键错误，范围为 Diskus 的 20%至 43%，Turbuhaler 的 32%至 100%。五项研究报告了吸入器错误与哮喘控制更差之间存在显著关联，而一项研究则表明两者之间无差异。
本 SLR 确定了两种装置均存在大量的吸入器错误。在各种装置中，更好的吸入技术与更好的哮喘结局相关。本系统综述证实了患者正确使用吸入器作为实现哮喘最佳结局的重要组成部分的重要性。
