Inhaler mishandling remains common in real life and is associated with reduced disease control

Andrea S. Melani, Marco Bonavia, Vincenzo Cilenti, Cristina Cinti, Marco Lodi, Paola Martucci, Maria Serra, Nicola Scichilone, Piersante Sestini, Maria Aliani, Margherita Neri

Research output: Contribution to journalArticlepeer-review

Abstract

Proper inhaler technique is crucial for effective management of asthma and COPD. This multicentre, cross-sectional, observational study investigates the prevalence of inhaler mishandling in a large population of experienced patients referring to chest clinics; to analyze the variables associated with misuse and the relationship between inhaler handling and health-care resources use and disease control. We enrolled 1664 adult subjects (mean age 62 years) affected mostly by COPD (52%) and asthma (42%). Respectively, 843 and 1113 patients were using MDIs and DPIs at home; of the latter, the users of Aerolizer ®, Diskus®, HandiHaler® and Turbuhaler® were 82, 467, 505 and 361. We have a total of 2288 records of inhaler technique. Critical mistakes were widely distributed among users of all the inhalers, ranging from 12% for MDIs, 35% for Diskus ® and HandiHaler® and 44% for Turbuhaler ®. Independently of the inhaler, we found the strongest association between inhaler misuse and older age (p = 0.008), lower schooling (p = 0.001) and lack of instruction received for inhaler technique by health caregivers (p < 0.001). Inhaler misuse was associated with increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), courses of oral steroids (p < 0.001) and antimicrobials (p < 0.001) and poor disease control evaluated as an ACT score for the asthmatics (p < 0.0001) and the whole population (p < 0.0001). We conclude that inhaler mishandling continues to be common in experienced outpatients referring to chest clinics and associated with increased unscheduled health-care resource use and poor clinical control. Instruction by health caregivers is the only modifiable factor useful for reducing inhaler mishandling.

Original languageEnglish (US)
Pages (from-to)930-938
Number of pages9
JournalRespiratory Medicine
Volume105
Issue number6
DOIs
StatePublished - Jun 2011

Keywords

  • Asthma
  • COPD
  • DPI
  • Inhaler technique
  • MDI
  • Patient education

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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