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Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes
Univ Aberdeen, Acad Primary Care, Polwarth Bldg, Aberdeen AB25 2ZD, Scotland.;Observat & Pragmat Res Inst Pte Ltd, Singapore, Singapore..
Inst Invest Sanitaria Palma IdisPa, Primary Care Resp Res Unit, Palma De Mallorca, Spain..
Univ Colorado, Skaggs Sch Pharm & Pharmaceut Sci, Dept Clin Pharm, Anschutz Med Campus, Aurora, CO USA..
Univ Sydney, Woolcock Inst Med Res, Sydney, NSW, Australia.;Sydney Local Hlth Dist, Sydney, NSW, Australia..
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2017 (English)In: Journal of Allergy and Clinical Immunology: In Practice, ISSN 2213-2198, E-ISSN 2213-2201, Vol. 5, no 4, 1071-1081.e9 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes.

OBJECTIVE: The CRITical Inhaler mistaKes and Asthma controL study investigated the association between specific inhaler errors and asthma outcomes.

METHODS: This analysis used data from the iHARP asthma review service-a multicenter cross-sectional study of adults with asthma. The review took place between 2011 and 2014 and captured data from more than 5000 patients on demographic characteristics, asthma symptoms, and inhaler errors observed by purposefully trained health care professionals. People with asthma receiving a fixed-dose combination treatment with inhaled corticosteroids and long-acting beta agonist were categorized by the controller inhaler device they used-dry-powder inhalers or metered-dose inhalers: inhaler errors were analyzed within device cohorts. Error frequency, asthma symptom control, and exacerbation rate were analyzed to identify critical errors.

RESULTS: This report contains data from 3660 patients. Insufficient inspiratory effort was common (made by 32%-38% of dry-powder inhaler users) and was associated with uncontrolled asthma (adjusted odds ratios [95% CI], 1.30 [1.08-1.57] and 1.56 [1.17-2.07] in those using Turbohaler and Diskus devices, respectively) and increased exacerbation rate. In metered-dose inhaler users, actuation before inhalation (24.9% of patients) was associated with uncontrolled asthma (1.55 [1.11-2.16]). Several more generic and device-specific errors were also identified as critical.

CONCLUSIONS: Specific inhaler errors have been identified as critical errors, evidenced by frequency and association with asthma outcomes. Asthma management should target inhaler training to reduce key critical errors.

Place, publisher, year, edition, pages
2017. Vol. 5, no 4, 1071-1081.e9 p.
Keyword [en]
Inhaler errors, Inhaler technique, Asthma control, Exacerbation
National Category
Respiratory Medicine and Allergy Immunology in the medical area
Identifiers
URN: urn:nbn:se:uu:diva-332326DOI: 10.1016/j.jaip.2017.01.004ISI: 000405981100026PubMedID: 28286157OAI: oai:DiVA.org:uu-332326DiVA: diva2:1153115
Available from: 2017-10-27 Created: 2017-10-27 Last updated: 2017-10-27Bibliographically approved

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Lisspers, KarinStällberg, Björn

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