Identifying patients at risk of poor asthma outcomes associated with making inhaler technique errors

Abstract

Objectives

Correct inhaler technique is essential to optimal clinical outcomes in asthma patients. The study aim was to use real-life data from the iHARP database to determine patient factors associated with the performance of inhaler technique errors associated with poor asthma outcomes (as identified in the Critikal study) in patients with asthma prescribed the Turbuhaler (TH), Metered Dose Inhaler (MDI), and Accuhaler (AH) device.

Methods

This was a retrospective cross-sectional study using the iHARP database, a multinational initiative including questionnaires and technique review. Identification of inhaler technique errors specifically associated with poor asthma outcomes was performed by reference to the Critikal study. Multivariable logistic regression was used to identify demographic and clinical factors associated with ≥ 1 of these errors.

Results

Factors significantly associated with ≥ 1 inhaler technique error and worsening asthma outcomes for the TH cohort include female gender, very poor to average self-assessment of inhaler technique; for the MDI cohort, female gender, secondary education, and current smoking status; and, in the AH cohort, lack of inhaler technique review by a trained healthcare professional in the previous twelve months and very poor to average self-assessment of inhaler technique.

Conclusions

Numerous specific patient demographic and clinical factors associated with the performance of these errors have been identified, differing according to device. Inhaler technique error associated with poor asthma outcomes is further widespread across devices. Knowledge of these factors and the frequency of their occurence may assist in optimizing device selection and training.

Keywords:

• Asthma therapy
• inhaler technique
• turbuhaler
• accuhaler
• pressurized metered dose inhaler
• database

Acknowledgements

The authors wish to acknowledge all the participants of the Observational and Pragmatic Research Institute for providing access to the iHARP data, and Mundipharma, for supporting the collection of data from the iHARP database via a research grant. No financial support from any entity was provided for this study.

Declaration of interest

In accordance with Taylor & Francis policy and my ethical obligation as a researcher, I am reporting the following conflicts of interest.

Grants from the Australian Research Council, Department of Health and Aging, University of Sydney, Commonwealth Govt of Australia (Guild Govt Agreement Scheme), Commonwealth Govt of Australia (Rural and Remote Pharmacy Workforce Development Program), NHMRC Co-operative Research Centre for Asthma, NHMRC Centre for Research Excellence in Severe Asthma, Asthma Foundation of NSW, Scherring Plough, TEVA Pharmaceuticals, AstraZeneca, Zentiva, Mundipharma International, MEDA Pharmaceuticals, Research in Real Life Pty (UK), University of Michigan, USA. Membership of Advisory Boards consultancies/Lecture honorarium: AZ, GSK, TEVA Pharmaceuticals, Mundipharma, Boehringer Ingelheim, Sanofi, Mylan.

Honoraria from AstraZeneca, GlaxoSmithKline and Pfizer, outside the submitted work.

Board membership with Aerocrine, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Mundipharma, Napp, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Teva Pharmaceuticals; consultancy agreements with Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Mundipharma, Napp, Novartis, Pfizer, Teva Pharmaceuticals, Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from Aerocrine, AKL Research and Development Ltd, AstraZeneca, Boehringer Ingelheim, British Lung Foundation, Chiesi, Mylan, Mundipharma, Napp, Novartis, Pfizer, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Teva Pharmaceuticals, Theravance, UK National Health Service, Zentiva (Sanofi Generics); payment for lectures/speaking engagements from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Merck, Mundipharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, Skyepharma, Teva Pharmaceuticals; payment for manuscript preparation from Mundipharma, Teva Pharmaceuticals; payment for the development of educational materials from Mundipharma, Novartis; payment for travel/accommodation/meeting expenses from Aerocrine, AstraZeneca, Boehringer Ingelheim, Mundipharma, Napp, Novartis, Teva Pharmaceuticals; funding for patient enrolment or completion of research from Chiesi, Novartis, Teva Pharmaceuticals, Zentiva (Sanofi Generics); stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); and is peer reviewer for grant committees of the Efficacy and Mechanism Evaluation programme, and Health Technology Assessment.

I have disclosed those interests fully to Taylor & Francis, and I have in place an approved plan for managing any potential conflicts arising from these involvements.