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Irregular and Ineffective: A Quantitative Observational Study of the Time and Technique of Inhaler Use

Sulaiman, Imran; Seheult, Jansen; MacHale, Elaine; D'Arcy, Shona; Boland, Fiona; McCrory, Katrina; Casey, John; Bury, Gerard; Al-Alawi, Mazen; O'Dwyer, Susan; Ryder, Sheila A; Reilly, Richard B; Costello, Richard W
BACKGROUND:Cross-sectional observational studies suggest that between 50% and 60% of patients misuse a dry powder inhaler, whereas studies with electronic monitors indicate that patients sometimes overuse/underuse their inhalers. It is not known what impact errors and erratic use have on inhaler adherence. OBJECTIVES:The purpose of this study was to longitudinally quantify when and how patients adhered to a twice-daily preventer treatment by using a novel acoustic recording device attached to an inhaler (INhaler Compliance Assessment). METHODS:Patients with a history of asthma or chronic obstructive pulmonary disease (n = 123) from primary care and community pharmacies were given an INhaler Compliance Assessment-adapted inhaler for 1 month. Analysis of the audio files provided quantitative information on time and technique of inhaler use. RESULTS:Data were available for 103 patients. Twenty-one patients (20%) used their inhaler in the correct manner at the correct interval. There were 5045 audio files with attempted inhalations, of which 1204 had technique errors (24%). Errors included inadequate flow (27%), drug priming without inhalation (19%), exhalation into the inhaler (18%), and multiple inhalations (25%). On average, participants made errors 20% of the time. Of 60 doses expected to be taken in a month per person, on average 49 doses (82%) were attempted and when errors were accounted for, the average number of actual doses taken was 34 doses (57%; P < .01) comparing attempted to actual doses. DISCUSSION:These data highlight that ineffective and irregular inhaler use is common and when combined in a single calculation indicate that only 20% of participants used their inhaler correctly and on time.
PMID: 27587321
ISSN: 2213-2201
CID: 4722112

Transcutaneous bilirubinometry: Comparison of two multiwavelength devices in healthy term newborns [Letter]

Teran C.G.; Mohamed T.; Casey J.
ISSN: 0340-6199
CID: 147759