A total of 45% of patients made at least 1 error when using an inhaler, and the number of errors per patient ranged from 1 to 6.
While inhaled therapies can reduce symptoms and reduce the frequency of exacerbations of chronic obstructive pulmonary disease (COPD), the benefits of these therapies depend in large part on correct use of inhalers. Recent data have suggested that as few as 31% of patients with respiratory diseases use their inhalers correctly, and one recent study sought to describe inhaler use among patients with COPD in the primary care setting.
The investigators recruited patients from 4 counties in Sweden to participate, and a total of 183 patients, who used a total of 324 devices, were assessed; 164 provided answers to a baseline questionnaire.
Two-thirds of the patients used more than one inhaler device, with a maximum of 4 inhalers per patient. The types of devices used included dry powder inhalers, pressurized meter-dose inhalers, and soft mist inhalers. In total, 45% of patients had experienced at least 1 exacerbation of their COPD in the past year.
A total of 45% of patients made at least 1 error when using an inhaler, and the number of errors per patient ranged from 1 to 6. The proportion of patients who made at least 1 error related to using an inhaler device was significantly larger than the proportion of the patients who made at least 1 error related to inhalation technique (50% versus 31%, P = .007). Additionally, 19% of patients made errors in both the device and technique categories.
The researchers reported that most of the errors occurred during dose preparation and inhalation technique, while a minority of errors took place in the device preparation or handling steps.
The most frequent errors were not exhaling slowly before inhalation (22%), not tilting the head upward (22%), exhaling into the inhaler (13%), and not placing the mouthpiece between the teeth (13%). No patients had errors related to inhaling through the nose or not moving the mouthpiece valve when inhaling.
According to the authors, “The fact that almost half of the patients in this study did not use their inhaler correctly shows the need for further assessment and training by healthcare professionals.” However, they add, only 15%-69% of healthcare professionals are able to demonstrate correct inhaler use.
Lindh A, Theander K, Arne M, et al. Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care. Nursing Open. 2019;00:1-9. doi: 10.1002/nop2.357.