Critical Inhaler Handling Error Is an Independent Risk Factor for Frequent Exacerbations of Chronic Obstructive Pulmonary Disease: Interim Results of a Single Center Prospective Study

Abstract

Objective

Chronic obstructive pulmonary disease (COPD) acute exacerbations are significant causes of morbidity and mortality. “Frequent exacerbator” phenotypes are considered a distinct subgroup and this phenotype has a negative effect on lung function, quality of life, activity, hospital admission, and mortality. We assess inhaler handling technique and adherence, and evaluate risk factors associated with frequent exacerbations in COPD patients.

Methods

This study was a cross-sectional, case-control study. We prospectively enrolled 189 COPD patients from Yeungnam University Hospital from January 2018 to November 2018. Subjects were tested regarding their inhaler technique in face-to-face interviews with an advanced practice nurse of inhaler upon study entry. Frequency of moderate to severe COPD exacerbations were reviewed via electronic medical records during 12 months prior to study entry. Frequent exacerbations were defined as ≥2 moderate to severe exacerbations in the prior 12 months. Multivariate logistic regression was performed to identify risk factors for frequent exacerbations.

Results

Among 189 COPD patients, 50 (26.5%) were frequent exacerbators. Based on univariate analyses, body mass index (BMI) < 25 kg/m², lower forced expiratory volume in 1 s (FEV₁), higher mMRC, lower feeling of satisfaction with the inhaler, and any critical errors were potential risk factors for frequent exacerbations. Multivariate logistic regression analyses revealed that BMI < 25 kg/m² (OR, 2.855, 95% CI, 1.247–6.534; p=0.013), higher mMRC (OR, 1.625, 95% CI, 1.072–2.463; p=0.022), and any critical error (OR, 2.020, 95% CI, 1.021–3.999; p=0.044) were risk factors.

Conclusion

Any critical error, BMI < 25 kg/m² and high mMRC are independent risk factors for frequent exacerbations in COPD patients. Careful monitoring and education around inhaler devices, particularly in frequent exacerbators, are important components of COPD treatment.

Keywords:

• COPD
• inhalation therapy
• drug use error
• disease exacerbation

Acknowledgments

We would like to express our appreciation to Mi Jeong Nam and Mi Suk Lee for gathering data for this study. Their devoted efforts were very helpful.

Ethical Statement

This study was conducted in accordance with the Declaration of Helsinki. It was reviewed and approved by the institutional review board of our hospital (YUH IRB 2017–09–012). Written informed consent was obtained from all patients.

Data Sharing Statement

The datasets generated during the study are available from the corresponding author upon reasonable request.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest.