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Misuse of inhalers among COPD patients in a community hospital in Taiwan

Authors Liang CY, Chen YJ, Sheu SM, Tsai CF, Chen W

Received 4 December 2017

Accepted for publication 2 February 2018

Published 23 April 2018 Volume 2018:13 Pages 1309—1316

DOI https://doi.org/10.2147/COPD.S158864

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Chunxue Bai


Chi-Yen Liang,1 Yi-Jen Chen,1 Shew-Meei Sheu,2 Ching-Fang Tsai,2 Wei Chen1

1Division of Pulmonary and Critical Care Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan; 2Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan

Purpose: Respiratory inhalers, which directly deliver medication to the airway, are important for controlling symptoms and preventing exacerbations of chronic obstructive pulmonary disease (COPD). The inhaler misuse rate of patients with COPD in Taiwan is unclear. In this study, the inhaler techniques and patient characteristics associated with incorrect inhaler techniques among patients with COPD were evaluated.
Patients and methods: This cross-sectional study enrolled 298 patients with COPD (mean age 72.10 years) who used at least one inhaler device. The following five types of inhalers were included: metered-dose inhaler (MDI) with spacer, Diskus®, Turbuhaler®, Respimat®, and Breezhaler®. The inhaler technique was evaluated step by step. Misuse of an individual inhaler was defined as an error in at least one step. The sociodemographic characteristics, vision, hearing ability, type and number of inhalers, and inhaler-related knowledge of these patients were recorded.
Results: The misuse rates of the five types of inhalers ranged from 65.00% to 87.89%. The Respimat inhaler was the most likely to be assembled incorrectly. The steps that were most commonly performed incorrectly were “breathing out fully” and “holding breath”. In the logistic regression analysis, poor hearing was related to misuse of the MDI with spacer (adjusted odds ratio [aOR] 9.85; 95% CI 1.40–69.30); the number of acute exacerbations was related to misuse of Breezhaler (aOR 4.07; 95% CI 1.50–11.08). Incorrect inhaler-related knowledge was significantly associated with misuse in handling the MDI with spacer (aOR 9.58; 95% CI 2.14–42.80), Respimat (aOR 5.14; 95% CI 2.07–12.76), and Breezhaler (aOR 6.98; 95% CI 1.95–25.08).
Conclusion: The misuse rates were high for all five types of inhaler. Poor hearing and the number of acute exacerbations were device-specific factors related to the misuse of inhalers. Inhaler-related knowledge was significantly associated with misuse, emphasizing the importance of inhaler education.

Keywords: misuse, inhaler, chronic obstructive pulmonary disease

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