Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Comparing Inhaler Use Technique Based on Inhaler Type in Elderly Patients with Respiratory Disease

  • Lee, Ha Youn (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Serim General Hospital) ;
  • Song, Jin Hwa (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Won, Ha-Kyeong (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Park, Yeonkyung (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Chung, Keun Bum (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Lim, Hyo-Jeong (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Ahn, Young Mee (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Lee, Byoung Jun (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center)
  • Received : 2020.03.04
  • Accepted : 2020.09.28
  • Published : 2021.01.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The aim of this study was to investigate inhaler device handling in elderly patients. Inhaler devices with respect to misuse and error correction were also compared. Methods: Inhaler use technique was assessed using standardized checklists at the first visit and 3-month follow-up visit after retraining. The primary outcome was difference in the acceptable use ratio among inhaler devices. Secondary outcomes included differences in error correction, the most common step of misuse, and factors affecting the accuracy of inhaler use. Results: A total of 251 patients (mean age, 76.4 years) were included. The handling of 320 devices was assessed in the study. All patients had been trained before. However, only 24.7% of them used inhalers correctly. Proportions of acceptable use for Evohaler, Respimat, Turbuhaler, Ellipta, and Breezhaler/Handihaler were 38.7%, 50.0%, 61.4%, 60.8%, and 43.2%, respectively (p=0.026). At the second visit, the acceptable use ratio had increased. There were no significant differences among inhaler types (Evohaler, 63.9%; Respimat, 86.1%; Turbuhaler, 74.3%; Ellipta, 64.6%; and Breezhaler/Handihaler, 65.3% [p=0.129]). In multivariate analysis, body mass index, Turbuhaler, and Ellipta showed positive correlations with acceptable use of inhalers, whereas Chronic Obstructive Pulmonary Disease Assessment Test score showed a negative correlation. Conclusion: Although new inhalers have been developed, the accuracy of inhaler use remains low. Elderly patients showed more errors when using pressurized metered-dose inhalers than using dry powder inhalers and soft-mist inhalers. However, there were no significant differences in misuse among inhaler devices after individual training. Results of this study suggests that repeat training is more important than inhaler type.

Keywords

Acknowledgement

This study was supported by grants from VHS Veterans Medical Research Institute.

References

  1. Dreher M, Muller T. Add-on therapy for symptomatic asthma despite long-acting beta-agonists/inhaled corticosteroid. Tuberc Respir Dis 2018;81:1-5. https://doi.org/10.4046/trd.2017.0102
  2. Park YB, Rhee CK, Yoon HK, Oh YM, Lim SY, Lee JH, et al. Revised (2018) COPD clinical practice guideline of the Korean Academy of Tuberculosis and Respiratory Disease: a summary. Tuberc Respir Dis 2018;81:261-73. https://doi.org/10.4046/trd.2018.0029
  3. Miravitlles M, Baek S, Vithlani V, Lad R. Optimal bronchodilation for COPD patients: are all long-acting β2-agonist/long-acting muscarinic antagonists the same? Tuberc Respir Dis 2018;81:198-215. https://doi.org/10.4046/trd.2018.0040
  4. Rogliani P, Calzetta L, Coppola A, Cavalli F, Ora J, Puxeddu E, et al. Optimizing drug delivery in COPD: the role of inhaler devices. Respir Med 2017;124:6-14. https://doi.org/10.1016/j.rmed.2017.01.006
  5. Bosnic-Anticevich SZ. Continued innovation in respiratory care: the importance of inhaler devices. Tuberc Respir Dis 2018;81:91-8. https://doi.org/10.4046/trd.2017.0119
  6. Lindgren S, Bake B, Larsson S. Clinical consequences of inadequate inhalation technique in asthma therapy. Eur J Respir Dis 1987;70:93-8.
  7. Epstein SW, Manning CP, Ashley MJ, Corey PN. Survey of the clinical use of pressurized aerosol inhalers. Can Med Assoc J 1979;120:813-6.
  8. Sanchis J, Gich I, Pedersen S; Aerosol Drug Management Improvement Team (ADMIT). Systematic review of errors in inhaler use: has patient technique improved over time? Chest 2016;150:394-406. https://doi.org/10.1016/j.chest.2016.03.041
  9. Bosnic-Anticevich SZ. Inhaler device handling: have we really started to address the problem? Eur Respir J 2017;49:1700120. https://doi.org/10.1183/13993003.00120-2017
  10. Molimard M, Raherison C, Lignot S, Balestra A, Lamarque S, Chartier A, et al. Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients. Eur Respir J 2017;49:1601794. https://doi.org/10.1183/13993003.01794-2016
  11. Armitage JM, Williams SJ. Inhaler technique in the elderly. Age Ageing 1988;17:275-8. https://doi.org/10.1093/ageing/17.4.275
  12. Molimard M, Raherison C, Lignot S, Depont F, Abouelfath A, Moore N. Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care. J Aerosol Med 2003;16:249-54. https://doi.org/10.1089/089426803769017613
  13. Wieshammer S, Dreyhaupt J. Dry powder inhalers: which factors determine the frequency of handling errors? Respiration 2008;75:18-25. https://doi.org/10.1159/000109374
  14. Mahon J, Fitzgerald A, Glanville J, Dekhuijzen R, Glatte J, Glanemann S, et al. Misuse and/or treatment delivery failure of inhalers among patients with asthma or COPD: a review and recommendations for the conduct of future research. Respir Med 2017;129:98-116. https://doi.org/10.1016/j.rmed.2017.05.004
  15. Chrystyn H, van der Palen J, Sharma R, Barnes N, Delafont B, Mahajan A, et al. Device errors in asthma and COPD: systematic literature review and meta-analysis. NPJ Prim Care Respir Med 2017;27:22. https://doi.org/10.1038/s41533-017-0016-z
  16. Kerwin EM, Preece A, Brintziki D, Collison KA, Sharma R. ELLIPTA dry powder versus metered-dose inhalers in an optimized clinical trial setting. J Allergy Clin Immunol Pract 2019;7:1843-9. https://doi.org/10.1016/j.jaip.2019.02.023
  17. Collison KA, Patel P, Preece AF, Stanford RH, Sharma RK, Feldman G. A randomized clinical trial comparing the ELLIPTA and HandiHaler dry powder inhalers in patients with COPD: inhaler-specific attributes and overall patient preference. COPD 2018;15:46-50. https://doi.org/10.1080/15412555.2017.1400000
  18. Liang CY, Chen YJ, Sheu SM, Tsai CF, Chen W. Misuse of inhalers among COPD patients in a community hospital in Taiwan. Int J Chron Obstruct Pulmon Dis 2018;13:1309-16. https://doi.org/10.2147/COPD.S158864
  19. Lee H, Boo S, Lim Y, Kim S, Kim IA. Accuracy of inhaler use in patients with chronic obstructive pulmonary disease. Clin Nurs Res 2014;23:560-74. https://doi.org/10.1177/1054773813498269
  20. Vanderman AJ, Moss JM, Bailey JC, Melnyk SD, Brown JN. Inhaler misuse in an older adult population. Consult Pharm 2015;30:92-100. https://doi.org/10.4140/TCP.n.2015.92
  21. Duarte-de-Araujo A, Teixeira P, Hespanhol V, Correia-deSousa J. COPD: misuse of inhaler devices in clinical practice. Int J Chron Obstruct Pulmon Dis 2019;14:1209-17. https://doi.org/10.2147/COPD.S178040
  22. Melani AS, Bonavia M, Mastropasqua E, Zanforlin A, Lodi M, Martucci P, et al. Time required to rectify inhaler errors among experienced subjects with faulty technique. Respir Care 2017;62:409-14. https://doi.org/10.4187/respcare.05117
  23. Altman P, Bergna MA, Garcia GR, Guerin T, Pino AV, Whiteford JL. Patient perception of Breezhaler((R)) and Ellipta((R)) device feedback mechanisms in COPD: the ADVANTAGE study. Curr Med Res Opin 2019;35:221-7. https://doi.org/10.1080/03007995.2018.1464437
  24. Svedsater H, Dale P, Garrill K, Walker R, Woepse MW. Qualitative assessment of attributes and ease of use of the ELLIPTA dry powder inhaler for delivery of maintenance therapy for asthma and COPD. BMC Pulm Med 2013;13:72. https://doi.org/10.1186/1471-2466-13-72
  25. Klijn SL, Hiligsmann M, Evers S, Roman-Rodriguez M, van der Molen T, van Boven JF. Effectiveness and success factors of educational inhaler technique interventions in asthma and COPD patients: a systematic review. NPJ Prim Care Respir Med 2017;27:24. https://doi.org/10.1038/s41533-017-0022-1
  26. Melani AS, Zanchetta D, Barbato N, Sestini P, Cinti C, Canessa PA, et al. Inhalation technique and variables associated with misuse of conventional metered-dose inhalers and newer dry powder inhalers in experienced adults. Ann Allergy Asthma Immunol 2004;93:439-46. https://doi.org/10.1016/S1081-1206(10)61410-X
  27. Rydman RJ, Sonenthal K, Tadimeti L, Butki N, McDermott MF. Evaluating the outcome of two teaching methods of breath actuated inhaler in an inner city asthma clinic. J Med Syst 1999;23:349-56. https://doi.org/10.1023/A:1020525116505
  28. Basheti IA, Armour CL, Bosnic-Anticevich SZ, Reddel HK. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Educ Couns 2008;72:26-33. https://doi.org/10.1016/j.pec.2008.01.014
  29. Geller DE. Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler. Respir Care 2005;50:1313-21.