Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting

Janine A. M. Westerik, Victoria Carter, Henry Chrystyn, Anne Burden, Samantha L. Thompson, Dermot Ryan, Kevin Gruffydd-Jones, John Haughney, Nicolas Roche, Federico Lavorini, Alberto Papi, Antonio Infantino, Miguel Roman-Rodriguez, Sinthia Bosnic-Anticevich, Karin Lisspers, Björn Ställberg, Svein Høegh Henrichsen, Thys van der Molen, Catherine Hutton, David B. Price

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Abstract

OBJECTIVE: Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI).

METHODS: This was a historical, multinational, cross-sectional study (2011-2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with ≥1 serious errors.

RESULTS: Of 3681 patients with asthma, 623 (17%) were using a Diskus (mean [SD] age, 51 [14]; 61% women). A total of 341 (55%) patients made ≥1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with ≥1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.26-3.40); obesity (OR 1.75; 1.17-2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04-2.36); female sex (OR 1.51; 1.08-2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04-2.02).

CONCLUSIONS: Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate.

Original languageEnglish
Pages (from-to)321-329
Number of pages9
JournalJournal of Asthma
Volume53
Issue number3
Early online date18 Jan 2016
DOIs
Publication statusPublished - 26 Jan 2016

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Dry Powder Inhalers
Nebulizers and Vaporizers
Primary Health Care
Asthma
Odds Ratio
Inhalation
Health Personnel
Sex Ratio
Hospitalization
Obesity
Cross-Sectional Studies
Logistic Models
Databases
Confidence Intervals
Equipment and Supplies

Keywords

  • asthma therapy
  • cross-sectional
  • Diskus inhaler
  • inhalation devices
  • multinational

Cite this

Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting. / Westerik, Janine A. M.; Carter, Victoria; Chrystyn, Henry; Burden, Anne; Thompson, Samantha L.; Ryan, Dermot; Gruffydd-Jones, Kevin; Haughney, John; Roche, Nicolas; Lavorini, Federico; Papi, Alberto; Infantino, Antonio; Roman-Rodriguez, Miguel; Bosnic-Anticevich, Sinthia; Lisspers, Karin; Ställberg, Björn; Henrichsen, Svein Høegh; van der Molen, Thys; Hutton, Catherine; Price, David B.

In: Journal of Asthma, Vol. 53, No. 3, 26.01.2016, p. 321-329.

Research output: Contribution to journalArticle

Westerik, JAM, Carter, V, Chrystyn, H, Burden, A, Thompson, SL, Ryan, D, Gruffydd-Jones, K, Haughney, J, Roche, N, Lavorini, F, Papi, A, Infantino, A, Roman-Rodriguez, M, Bosnic-Anticevich, S, Lisspers, K, Ställberg, B, Henrichsen, SH, van der Molen, T, Hutton, C & Price, DB 2016, 'Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting', Journal of Asthma, vol. 53, no. 3, pp. 321-329. https://doi.org/10.3109/02770903.2015.1099160
Westerik, Janine A. M. ; Carter, Victoria ; Chrystyn, Henry ; Burden, Anne ; Thompson, Samantha L. ; Ryan, Dermot ; Gruffydd-Jones, Kevin ; Haughney, John ; Roche, Nicolas ; Lavorini, Federico ; Papi, Alberto ; Infantino, Antonio ; Roman-Rodriguez, Miguel ; Bosnic-Anticevich, Sinthia ; Lisspers, Karin ; Ställberg, Björn ; Henrichsen, Svein Høegh ; van der Molen, Thys ; Hutton, Catherine ; Price, David B. / Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting. In: Journal of Asthma. 2016 ; Vol. 53, No. 3. pp. 321-329.
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abstract = "OBJECTIVE: Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI).METHODS: This was a historical, multinational, cross-sectional study (2011-2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with ≥1 serious errors.RESULTS: Of 3681 patients with asthma, 623 (17{\%}) were using a Diskus (mean [SD] age, 51 [14]; 61{\%} women). A total of 341 (55{\%}) patients made ≥1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with ≥1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95{\%} confidence interval [CI], 1.26-3.40); obesity (OR 1.75; 1.17-2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04-2.36); female sex (OR 1.51; 1.08-2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04-2.02).CONCLUSIONS: Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate.",
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note = "Acknowledgements The iHARP database was funded by unrestricted grants from Mundipharma International Ltd and Research in Real-Life Ltd; these analyses were funded by an unrestricted grant from Teva Pharmaceuticals. Mundipharma and Teva played no role in study conduct or analysis and did not modify or approve the manuscript. The authors wish to direct a special appreciation to all the participants of the iHARP group who contributed data to this study and to Mundipharma, sponsors of the iHARP group. In addition, we thank Julie von Ziegenweidt for assistance with data extraction and Anna Gilchrist and Valerie L. Ashton, PhD, for editorial assistance. Elizabeth V. Hillyer, DVM, provided editorial and writing support, funded by Research in Real-Life, Ltd.",
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TY - JOUR

T1 - Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting

AU - Westerik, Janine A. M.

AU - Carter, Victoria

AU - Chrystyn, Henry

AU - Burden, Anne

AU - Thompson, Samantha L.

AU - Ryan, Dermot

AU - Gruffydd-Jones, Kevin

AU - Haughney, John

AU - Roche, Nicolas

AU - Lavorini, Federico

AU - Papi, Alberto

AU - Infantino, Antonio

AU - Roman-Rodriguez, Miguel

AU - Bosnic-Anticevich, Sinthia

AU - Lisspers, Karin

AU - Ställberg, Björn

AU - Henrichsen, Svein Høegh

AU - van der Molen, Thys

AU - Hutton, Catherine

AU - Price, David B.

N1 - Acknowledgements The iHARP database was funded by unrestricted grants from Mundipharma International Ltd and Research in Real-Life Ltd; these analyses were funded by an unrestricted grant from Teva Pharmaceuticals. Mundipharma and Teva played no role in study conduct or analysis and did not modify or approve the manuscript. The authors wish to direct a special appreciation to all the participants of the iHARP group who contributed data to this study and to Mundipharma, sponsors of the iHARP group. In addition, we thank Julie von Ziegenweidt for assistance with data extraction and Anna Gilchrist and Valerie L. Ashton, PhD, for editorial assistance. Elizabeth V. Hillyer, DVM, provided editorial and writing support, funded by Research in Real-Life, Ltd.

PY - 2016/1/26

Y1 - 2016/1/26

N2 - OBJECTIVE: Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI).METHODS: This was a historical, multinational, cross-sectional study (2011-2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with ≥1 serious errors.RESULTS: Of 3681 patients with asthma, 623 (17%) were using a Diskus (mean [SD] age, 51 [14]; 61% women). A total of 341 (55%) patients made ≥1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with ≥1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.26-3.40); obesity (OR 1.75; 1.17-2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04-2.36); female sex (OR 1.51; 1.08-2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04-2.02).CONCLUSIONS: Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate.

AB - OBJECTIVE: Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI).METHODS: This was a historical, multinational, cross-sectional study (2011-2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with ≥1 serious errors.RESULTS: Of 3681 patients with asthma, 623 (17%) were using a Diskus (mean [SD] age, 51 [14]; 61% women). A total of 341 (55%) patients made ≥1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with ≥1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.26-3.40); obesity (OR 1.75; 1.17-2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04-2.36); female sex (OR 1.51; 1.08-2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04-2.02).CONCLUSIONS: Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate.

KW - asthma therapy

KW - cross-sectional

KW - Diskus inhaler

KW - inhalation devices

KW - multinational

U2 - 10.3109/02770903.2015.1099160

DO - 10.3109/02770903.2015.1099160

M3 - Article

VL - 53

SP - 321

EP - 329

JO - Journal of Asthma

JF - Journal of Asthma

SN - 0277-0903

IS - 3

ER -