Despite New Types, Correct Inhaler Use Remains Low Among Elderly Patients With COPD

New study findings indicate that accurate inhaler use remains low among elderly patients with chronic obstructive pulmonary disease (COPD).

Despite all 200 patients included in the study being previously trained on their inhalers, just under 1 in 4 (24.7%) used them correctly. According to the researchers, correct usage was not dependent on which of the 5 inhaler types the patient used.

These findings underscore the importance of repeat training to increase rates of correct inhaler use over inhaler type, as poor inhaler use is associated with poor disease control and frequent disease exacerbation.

“Although new devices have been developed, these data are consistent with previous studies and demonstrate that the accuracy of inhaler use remains low,” explained the researchers.

When looking at the number of patients who demonstrated “acceptable use” of their inhaler, the rate nearly doubled to 49.4% at first assessment. Use of inhaler devices was considered “acceptable” if patients checked 4 or more of 5 steps included in the researchers’ checklist:

• Step 1 and 2: exhale while assembling and hold the inhaler correctly
• Step 3: breathe out fully
• Step 4: deeply inhale
• Step 5: hold the breath

Rates of “acceptable use” were impacted by inhaler device type, as Turbuhaler users exhibited the greatest proportion of acceptable use (61.4%), followed by Ellipta users (60.8%), Respimat users (50%), Breezhaler/Handihaler users (43.2%), and Evohaler users (38.7%).

Similarly, Turbuhaler users had the highest mean checklist score with an average of 3.71 points while Evohaler users had the lowest mean checklist score with an average of 2.89 points.

Study investigators, who assessed inhaler use among patients between June 2018 and July 2019, checked inhaler use and then demonstrated correct use through a face-to-face discussion if patients made errors. Patients’ inhaler usage was re-evaluated after 3 months.

“After education, the significant differences in error frequency among devices disappeared,” wrote the researchers. They added, “However, the analysis of each step revealed that Evohaler users performed more errors than users of other devices in the assembly (pre-inhalation) and inhalation steps even after training. Notably, Ellipta showed the lowest correction rate and Respimat showed the highest correction rate after 1-on-1 face-to-face training.”

The researchers offered 2 potential reasons for this finding. The real-world study design meant that because patients kept using the device they were already using, rather than being randomly assigned an inhaler, Ellipta might have been used by more patients with reduced cognitive and manipulation skills as the inhaler type is easy to operate.

The second proposed reason was related to the time at which the error occurred. More errors were made in exhalation, inhalation, and breath hold among patients using Ellipta, and these errors are harder to improve compared with preparation errors.

Reference: Lee HY, Song JH, Won H, et al. Comparison of inhaler use technique based on inhaler type in elderly patients with respiratory disease. Tuberc Respir Dis. Published online September 28, 2020. doi:10.4046/trd.2020.0021