Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD

doi:10.1016/J.RMED.2007.11.003

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Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD

Journal Article•DOI•

Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD

Federico Lavorini¹, Antoine Magnan², Antoine Magnan³, Jean Christophe Dubus, Thomas Voshaar, Lorenzo Corbetta¹, Mariëlle E.A.C. Broeders, Richard Dekhuijzen, Joaquín Sanchis⁴, José Luis Viejo, Peter J. Barnes⁵, Christopher Corrigan⁶, Mark L Levy⁷, Graham K. Crompton - Show less +10 more•Institutions (7)

University of Florence¹, University of Nantes², French Institute of Health and Medical Research³, Autonomous University of Barcelona⁴, National Institutes of Health⁵, King's College London⁶, University of Edinburgh⁷

01 Apr 2008-Respiratory Medicine (Elsevier)-Vol. 102, Iss: 4, pp 593-604

TL;DR: It is demonstrated that incorrect DPI technique with established DPIs is common among patients with asthma and COPD, and suggests that poor inhalation technique has detrimental consequences for clinical efficacy.

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About: This article is published in Respiratory Medicine.The article was published on 2008-04-01 and is currently open access. It has received 542 citations till now. The article focuses on the topics: Dry-powder inhaler & Inhaler.

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Citations

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Journal Article•DOI•

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

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Andrea S. Melani, Marco Bonavia, Vincenzo Cilenti, Cristina Cinti, Marco Lodi, Paola Martucci, Maria Serra, Nicola Scichilone¹, Piersante Sestini², Maria Aliani, Margherita Neri - Show less +7 more•Institutions (2)

University of Palermo¹, University of Siena²

01 Jun 2011-Respiratory Medicine

TL;DR: In this paper, the authors investigated 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.

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681 citations

Journal Article•DOI•

What the pulmonary specialist should know about the new inhalation therapies

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Beth L. Laube¹, Hettie M. Janssens², F.H.C. de Jongh, Sunalene G. Devadason³, Rajiv Dhand⁴, Patrice Diot, Mark L. Everard⁵, Ildiko Horvath⁶, Paolo Navalesi⁷, T. Voshaar, Henry Chrystyn⁸ - Show less +7 more•Institutions (8)

Johns Hopkins University¹, Erasmus University Rotterdam², University of Western Australia³, University of Missouri⁴, Boston Children's Hospital⁵, Semmelweis University⁶, University of Eastern Piedmont⁷, University of Huddersfield⁸

01 Jun 2011-European Respiratory Journal

TL;DR: A collaboration of multidisciplinary experts on the delivery of pharmaceutical aerosols was facilitated by the European Respiratory Society and the International Society for Aerosols in Medicine to draw up a consensus statement with clear, up-to-date recommendations that enable the pulmonary physician to choose the type of aerosol delivery device that is most suitable for their patient.

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Abstract: A collaboration of multidisciplinary experts on the delivery of pharmaceutical aerosols was facilitated by the European Respiratory Society (ERS) and the International Society for Aerosols in Medicine (ISAM), in order to draw up a consensus statement with clear, up-to-date recommendations that enable the pulmonary physician to choose the type of aerosol delivery device that is most suitable for their patient. The focus of the consensus statement is the patient-use aspect of the aerosol delivery devices that are currently available. The subject was divided into different topics, which were in turn assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. To achieve consensus, draft reports and recommendations were reviewed and voted on by the entire panel. Specific recommendations for use of the devices can be found throughout the statement. Healthcare providers should ensure that their patients can and will use these devices correctly. This requires that the clinician: is aware of the devices that are currently available to deliver the prescribed drugs; knows the various techniques that are appropriate for each device; is able to evaluate the patient's inhalation technique to be sure they are using the devices properly; and ensures that the inhalation method is appropriate for each patient.

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586 citations

Journal Article•DOI•

Aerosol drug delivery: developments in device design and clinical use.

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Myrna Dolovich¹, Rajiv Dhand²•Institutions (2)

McMaster University¹, University of Missouri²

19 Mar 2011-The Lancet

TL;DR: Recent developments in the design and clinical use of aerosol devices over the past 10-15 years are discussed with an emphasis on the treatment of respiratory disorders.

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421 citations

Journal Article•DOI•

Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time?

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Joaquín Sanchis¹, Ignasi Gich¹, Søren Pedersen²•Institutions (2)

Autonomous University of Barcelona¹, University of Southern Denmark²

01 Aug 2016-Chest

TL;DR: In this paper, a systematic search for articles reporting direct observation of inhaler technique by trained personnel covered the period from 1975 to 2014, and the authors aimed to assess the most common errors in inhaler use over the past 40 years in patients treated with MDIs or dry powder inhalers (DPIs).

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370 citations

Cites background from "Effect of incorrect use of dry powd..."

...Exhale and seal chamber outlet with lips 34 (20-50) Child (n 1⁄4 8) 21 (8-38)...
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Journal Article•DOI•

Asthma in older adults

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Peter G. Gibson¹, Peter G. Gibson², Peter G. Gibson³, Vanessa M. McDonald³, Vanessa M. McDonald², Guy B. Marks⁴, Guy B. Marks⁵, Guy B. Marks¹ - Show less +4 more•Institutions (5)

Woolcock Institute of Medical Research¹, John Hunter Hospital², University of Newcastle³, University of New South Wales⁴, Liverpool Hospital⁵

04 Sep 2010-The Lancet

TL;DR: Increased attention to the complications of asthma and obstructive airway disease in older people is needed, specifically to develop effective systems of care, appropriate clinical practice guidelines, and a research agenda that delivers improved health outcomes.

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349 citations

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References

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Journal Article•DOI•

Universities and tobacco money.

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Joanna E. Cohen¹•Institutions (1)

University of Toronto¹

07 Jul 2001-BMJ

TL;DR: Nottingham University's establishment of an international centre for corporate social responsibility, with initial funding of £3.8m provided by British American Tobacco, joins a long list of universities that have accepted funding from the tobacco industry.

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Abstract: In December 2000 Nottingham University announced the establishment of an international centre for corporate social responsibility, with initial funding of £3.8m provided by British American Tobacco (BAT). To protest aganst their university's acceptance of money from the tobacco industry, an MBA student refused to accept his “student of the year” award; Richard Smith, editor of the BMJ , resigned from his post as professor of medical journalism; a cancer research team decided to relocate; and a member of the European parliament relinquished her roles at the university. Nottingham joins a long list of universities that have accepted funding from the tobacco industry. Other academic institutions have, however, taken the opposite stance and severed their ties with this industry. For example, Brigham and Women's and Massachusetts General hospitals in Boston, the MD Anderson Cancer Center in Houston, the Roswell Park Cancer Institute in Buffalo, and the University of Sydney all have policies precluding acceptance of research funds from the tobacco industry.1 The …

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923 citations

Journal Article•DOI•

Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability

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Violaine Giraud¹, Nicolas Roche•Institutions (1)

University of Paris¹

01 Feb 2002-European Respiratory Journal

TL;DR: Misuse of pressurized metered-dose inhalers, which is mainly due to poor coordination, is frequent and associated with poorer asthma control in inhaled corticosteroid-treated asthmatics, highlighting the importance of evaluating inhalation technique and providing appropriate education in all patients.

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Abstract: This study assessed whether the improper use of pressurized metered-dose inhalers (pMDIs) is associated with decreased asthma control in asthmatics treated by inhaled corticosteroids (ICS). General practitioners (GPs) included consecutive asthmatic outpatients treated by pMDI-administered ICS and on-demand, short-acting beta2-agonists. They measured an asthma instability score (AIS) based on daytime and nocturnal symptoms, exercise-induced dyspnoea, beta2-agonist usage, emergency-care visits and global perception of asthma control within the preceding month; the inhalation technique of the patient also was assessed. GPs (n=915) included 4,078 adult asthmatics; 3,955 questionnaires were evaluable. pMDI was misused by 71% of patients, of which 47% was due to poor coordination. Asthma was less stable in pMDI misusers than in good users (AIS: 3.93 versus 2.86, p<0.001). Among misusers, asthma was less stable in poor coordinators (AIS: 4.38 versus 3.56 in good coordinators, p<0.001). To conclude, misuse of pressurized metered-dose inhalers, which is mainly due to poor coordination, is frequent and associated with poorer asthma control in inhaled corticosteroid-treated asthmatics. This study highlights the importance of evaluating inhalation technique and providing appropriate education in all patients, especially before increasing inhaled corticosteroid dosage or adding other agents. The use of devices which alleviate coordination problems should be reinforced in pressurized metered-dose inhaler misusers.

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513 citations

Journal Article•DOI•

Regional lung deposition and bronchodilator response as a function of beta2-agonist particle size.

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Omar S. Usmani¹, Martyn F. Biddiscombe, Peter J. Barnes•Institutions (1)

National Institutes of Health¹

15 Dec 2005-American Journal of Respiratory and Critical Care Medicine

TL;DR: Regional targeting of inhaled beta2-agonist to the proximal airways is more important than distal alveolar deposition for bronchodilation and can appreciably enhance inhaled drug therapy and may have implications for developing future inhaled treatments.

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Abstract: Rationale: Aerosol particle size influences the extent, distribution, and site of inhaled drug deposition within the airways.Objectives: We hypothesized that targeting albuterol to regional airways by altering aerosol particle size could optimize inhaled bronchodilator delivery.Methods: In a randomized, double-blind, placebo-controlled study, 12 subjects with asthma (FEV1, 76.8 ± 11.4% predicted) inhaled technetium-99m–labeled monodisperse albuterol aerosols (30-μg dose) of 1.5-, 3-, and 6-μm mass median aerodynamic diameter, at slow (30–60 L/min) and fast (> 60 L/min) inspiratory flows. Lung and extrathoracic radioaerosol deposition were quantified using planar γ-scintigraphy. Pulmonary function and tolerability measurements were simultaneously assessed. Clinical efficacy was also compared with unlabeled monodisperse albuterol (15-μg dose) and 200 μg metered-dose inhaler (MDI) albuterol.Results: Smaller particles achieved greater total lung deposition (1.5 μm [56%], 3 μm [50%], and 6 μm [46%]), farther d...

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503 citations

"Effect of incorrect use of dry powd..." refers background in this paper

...43–6 mm) which are mainly deposited in the large airways where they exert their greatest effect whist minimising systemic effects.(47) In contrast, it is likely that inhaled corticosteroids would exert greatest effect if delivered as smaller particles which can reach the peripheral lung regions and corresponding sites of inflammation....
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...3–6 mm diameter) exert a greater bronchodilator effect when inhaled at a slower speed.(47) The situation is further complicated by the fact that the ideal particle size can vary depending on the inhaled active drug....
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...Furthermore, the clinical significance of inhalation speed seems to vary with particle size.(47) While small particles (i....
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Journal Article•DOI•

Inhaled corticosteroids for asthma therapy: patient compliance, devices, and inhalation technique.

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Mac G. Cochrane¹, Mohan V. Bala, Kristen E. Downs², Josephine Mauskopf², Rami Ben-Joseph³ - Show less +1 more•Institutions (3)

Guy's Hospital¹, Research Triangle Park², Merck & Co.³

01 Feb 2000-Chest

TL;DR: It is demonstrated that multiple factors may come between a prescription of an inhaled corticosteroid and the arrival of that medicine at its target organ, the lung.

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441 citations

"Effect of incorrect use of dry powd..." refers background or result in this paper

...Incorrect use of inhalers can lead to detrimental effects on asthma management(44); nevertheless, studies have shown that patients do not comply with the individual steps of the inhalation maneouvre.(2) Table 3 summarises studies involving adult and paediatric patients with asthma exhibiting specific errors in inhalation technique with established DPIs....
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...They allow high lung deposition of the drug and minimise systemic bioavailability, thus reducing possible systemic adverse drug reactions.(1,2) Pressurised metered dose inhalers (pMDIs) and dry powder inhalers (DPIs) are the devices most commonly used for drug delivery in the treatment of asthma and chronic obstructive pulmonary disease (COPD)....
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...Drugs for inhalation are the cornerstone of therapy in obstructive lung disease.(1,2) Inhalers are the principle vehicles for the effective administration of asthma medication....
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Journal Article•DOI•

Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care.

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Mathieu Molimard, Chantal Raherison, Séverine Lignot, F. Depont, Abdelilah Abouelfath, Nicholas Moore - Show less +2 more

01 Jan 2003-Journal of Aerosol Medicine-deposition Clearance and Effects in The Lung

TL;DR: The results suggest that there are differences in the handling of inhaler devices in real life in primary care that are not taken into account in controlled studies.

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Abstract: The correct use of inhalation devices is an inclusion criterion for all studies comparing inhaled treatments. In real life, however, patients may make many errors with their usual inhalation device, which may negate the benefits observed in clinical trials. Our study was undertaken to compare inhalation device handling in real life. A total of 3811 patients treated for at least 1 month with an inhalation device (Aerolizer®, Autohaler®, Diskus®, pressurized metered dose inhaler (pMDI), or Turbuhaler®) were included in this observational study performed in primary care in France between February 1st and July 14th, 2002. General practitioners had to assess patient handling of their usual inhaler device with the help of a checklist established for each inhaler model, from the package leaflet. Seventy-six percent of patients made at least one error with pMDI compared to 49-55% with breath-actuated inhalers. Errors compromising treatment efficacy were made by 11-12% of patients treated with Aerolizer®, Autohale...

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377 citations

"Effect of incorrect use of dry powd..." refers background or methods in this paper

...Molimard et al.12 defined lack of exhalation before inhalation and failure to breath-hold post-inhalation as device-independent errors.12 Inhaler errors were defined as critical if they could have substantially affected dose delivery to the lung....
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...Studies have shown that children experience the same problems as adults in the correct use of inhalers.6,7,41–43 Table 2 shows percentages of children who did not perform the inhalation technique correctly in a number of studies using different DPIs....
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...Critical errors for all DPIs included lack of inhalation through the mouthpiece and blowing into the device before inhalation.(12) However, it should be noted that exhaling into a DPI would be of greater significance with bulk reservoir devices such as the Turbuhaler, but less so for the Diskus in which unit doses are sealed until priming....
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...Molimard et al.(12) conducted an observational study of 3811 patients with asthma or COPD....
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...Molimard et al.(12) defined lack of exhalation before inhalation and failure to breath-hold post-inhalation as device-independent errors....
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