Does the number of inhalers used by patients with asthma and COPD determine number of mistakes in inhalation technique?

Abstract

Introduction: proper inhalation technique is essential for effective therapy in asthma and chronic obstructive pulmonary disease (COPD). The use of the smallest possible number of different inhalers (particularly, the avoidance of the concomitant use of metered dose inhalers, MDI, and dry powder inhalers, DPI) is recommended to minimize the risk of inhaler mishandling.

Aim: to analyze the number of inhalation errors in relation to the number of inhalers used by patients with asthma and COPD

Methods: the number, type of inhalers and inhalation errors was evaluated in consecutive patients with asthma and COPD using > 1 inhaler on a regular basis.

Results: 110 patients (55 asthma, 55 COPD; 59F, 51M; median age 67 years, median disease duration 10 years) were included. The median number of different inhalers per patient was 3 (IQR 2-3); 70 patients (64%) used ≥3 inhalers. 84 patients (76%) used MDI and DPI. The median number of mistakes in inhalation technique per patient was 4 (IQR 2-6). The number of inhalers used tended to correlate with the number of inhalation errors, however this correlation did not reach statistical significance (r=0,2, p=0.056). We did not find differences in number of used inhalers between patients, who made <3 and ≥ 3 inhalation errors.

Conclusions: despite the current recommendations on inhaled therapy, the majority of patients with asthma and COPD still use more than two types of inhalers on a regular basis. The number of inhalers used was not related with the number of inhalation errors in our investigated group.