Identifying critical inhalation technique errors in Dry Powder Inhaler use in patients with COPD based on the association with health status and exacerbations: findings from the multi-country cross-sectional observational PIFotal study

BMC Pulmonary Medicine

Research

Omar Usmani¹  Asparuh Gardev²  Jaco Voorham³  Federico Lavorini⁴  Radosław Gawlik⁵  Ioanna Tsiligianni⁶  Tiago Maricoto⁷  Iris van der Ham⁸  Ymke Janse⁸  Lars Dijk⁸  Kirsten Schuttel⁸  Boyd Metz⁸  Joyce van Cooten⁸  Jiska Meijer⁸  Marika T. Leving⁸  Nilouq Stoker⁸  Janwillem Kocks⁹  Jaime Correia de Sousa^1,10  David Price^1,11  Miguel Roman Rodriguez^1,12  Marina Garcia Pardo^1,12  Richard Dekhuijzen^1,13  Biljana Cvetkovski^1,14  Sinthia Bosnic-Anticevich^1,15 

[1] Airway Disease, National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, UK;Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany;Data to Insights Research Solutions, Lisbon, Portugal;Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy;Department of Internal Medicine, Allergology, Clinical Immunology, Medical University of Silesia, Katowice, Poland;Department of Social Medicine, Health Planning Unit, Faculty of Medicine, University of Crete, Rethymno, Greece;Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal;General Practitioners Research Institute, Professor Enno Dirk Wiersmastraat 5, 9713 GH, Groningen, The Netherlands;General Practitioners Research Institute, Professor Enno Dirk Wiersmastraat 5, 9713 GH, Groningen, The Netherlands;University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands;Observational and Pragmatic Research Institute, Singapore, Singapore;Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal;Observational and Pragmatic Research Institute, Singapore, Singapore;Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK;Primary Care Respiratory Research Unit, Instituto De Investigación Sanitaria De Baleares (IdISBa), Palma, Spain;Radboud University Medical Center, Nijmegen, Netherlands;Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia;Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia;Sydney Local Health District, Sydney, Australia;

关键词: Chronic Obstructive Pulmonary Disease;    Inhaler technique;    Inhaler errors;    COPD health status;    Exacerbation;   

DOI  :  10.1186/s12890-023-02566-6

 received in 2023-02-01, accepted in 2023-07-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCorrect inhaler use depends on a complex interplay of factors, including device preparation and generating sufficient inspiratory flow. It is currently unknown which inhalation technique errors can be considered critical in Chronic Obstructive Pulmonary Disease (COPD) patients on Dry Powder Inhaler (DPI) maintenance therapy.ObjectiveTo investigate the association between inhalation technique errors and health status or exacerbations in patients with COPD. Additionally, the association between the number of errors and COPD outcomes was determined.MethodsThe PIFotal study is a cross-sectional multi-country observational study in a primary care setting, including 1434 COPD patients aged ≥ 40 years (50.1% female; mean age 69.2 yrs) using a DPI for their maintenance therapy. Inhalation technique was video recorded and scored by two independent researchers using inhaler-specific checklists. Health status was assessed with two questionnaires; the Clinical COPD Questionnaire (CCQ) and the COPD Assessment Test (CAT). The number of moderate and severe exacerbations in the past 12 months was recorded. Critical errors were identified based on their association with health status or exacerbations through multi-level prediction models adjusted for identified confounding.ResultsErrors in inhalation technique steps ‘Breathe in’, ‘Hold breath’, and ‘Breathe out calmly after inhalation’ were significantly associated with poorer CCQ and CAT outcomes and thus deemed critical. None of the errors were significantly associated with moderate exacerbations. Patients with errors ‘Preparation’, ‘Hold inhaler in correct position during inhalation’, and ‘Breathe in’ had significantly more severe exacerbations, and therefore these errors were also deemed critical. 81.3% of patients with COPD made at least one critical error. Specific combinations of errors were associated with worse outcomes. The more inhalation technique errors identified, the poorer the health status and the higher the exacerbation rate.ConclusionIn this study, we identified multiple critical inhalation technique errors in COPD patients using DPIs each associated with poorer outcomes. Explorative analysis revealed that specific combinations of errors may be of clinical relevance, especially those related to the inhalation manoeuvre. COPD outcomes worsened with increasing error count. These results warrant further prospective longitudinal studies to establish the effect of correcting these errors on COPD control.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04532853 (31/08/2020)

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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