Comparative Study of Inhaler Device Handling Technique and Risk Factors for Critical Inhaler Errors in Korean COPD Patients

Abstract

Objective

Critical inhaler handling errors are associated with an increased risk of adverse outcomes in patients with chronic obstructive pulmonary disease (COPD). However, real-world data on inhaler device handling techniques and the risk factors for critical inhaler errors in the Asian population have been examined in only a few studies. We evaluated the rates and risk factors for critical inhaler errors in the COPD population in Korea.

Methods

COPD patients were prospectively enrolled from January 2018 to November 2019. An advanced practice nurse evaluated their inhaler technique. The 308 inhalers used by the 261 participants in this study included dry powder inhalers (DPIs; Turbuhaler, Breezhaler, Ellipta, Diskus, Genuair), a soft mist inhaler (SMI; Respimat), and pressurized metered dose inhalers (pMDIs).

Results

The percentage critical errors for Turbuhaler, Breezhaler, Ellipta, Diskus, Genuair, Respimat, and pMDI usage were 60.0%, 41.0%, 27.8%, 12.5%, 44.4%, 45.5%, and 55.0%, respectively. In the multivariate analyses, female sex, short COPD duration, dissatisfaction with the inhaler (assessed by FSI-10), and moderate acute exacerbations (AEs) in the prior year were independent risk factors for any critical error in the DPI group. In the SMI group, a low education level and frequent AEs in the prior year were independent risk factors for any critical error, whereas a high COPD assessment test (CAT) score was the only risk factor in the pMDI group.

Conclusion

Critical inhaler errors are common among patients with COPD, regardless of their preferred inhaler device. The rates and risk factors for critical inhaler errors differed among patients using different devices. Optimal device selection considering the risk factors of inhaler misusage will improve disease control in COPD patients.

Keywords:

• COPD
• inhalation therapy
• error
• risk factor

Data Sharing Statement

The datasets are available from the corresponding author (June Hong Ahn) on reasonable request.

Ethics Statement

This study was conducted in accordance with all relevant tenets of the Declaration of Helsinki. The protocol was reviewed and approved by the Institutional Review Board of our hospital (no. YUH IRB 2017-09-012-001). Written informed consent was obtained from all patients.

Acknowledgments

We sincerely thank Mi Suk Lee for assisting with this study and Mi Jeong Nam for her invaluable efforts with respect to data collection.

Author Contributions

Concept and design: Jang JG, Ahn JH, Lee KH

Acquisition, analysis, or interpretation of data: Jang JG, Ahn JH, Lee KH

Drafting of the manuscript: Ahn JH

Critical revision of the manuscript: All authors

Statistical Analysis: Jang JG, Ahn JH

Obtained funding: Ahn JH

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

There are no competing interests in this work.

Additional information

Funding

This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science & ICT(grant number 2021M3E5D1A0201526521 and 2021R1C1C100950811).