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      International Journal of COPD (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on pathophysiological processes underlying Chronic Obstructive Pulmonary Disease (COPD) interventions, patient focused education, and self-management protocols. Sign up for email alerts here.

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      Use of Web-Based Videos in a Community Pharmacy to Optimize Inhalation Technique

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          Abstract

          Purpose

          Numerous studies have demonstrated that incorrect use of inhalers prescribed to treat airway diseases is commonly observed and is associated with unfavorable clinical outcomes. The aim of the current study was to investigate whether inhalation technique can be improved by the demonstration of short training video sequences provided by the German Airway League.

          Patients and Methods

          Patients filling a script for an inhalator in a community pharmacy were asked to demonstrate their inhalation technique which was rated using specific checklists. Patients not inhaling correctly demonstrated inhaler use again after having viewing the training video.

          Results

          A total of 229 (n=229) patients were included in the study of whom 165 (n=165) (72.1%) made at least one critical mistake when inhaling. Training videos were only demonstrated to patients with incorrect inhaler technique. After having watched the video 80 (n=80) of 165 (n=165) (48.5%) patients with incorrect inhaler use at baseline demonstrated correct inhalation technique now and the number of critical mistakes decreased significantly (1 [0; 1] vs 2 [1.5; 3]; p<0.0001). Device use was demonstrated by a member of the study team to patients still not inhaling correctly (n=85) resulting in a correct technique in 64 (n=64) (75.3%) of these patients.

          Conclusion

          Incorrect device use is still a major problem. Training videos could be an efficient part of a multi-modal approach to improve inhalation technique in clinical practice.

          Most cited references22

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

          Proper inhaler technique is crucial for effective management of asthma and COPD. This multicentre, cross-sectional, observational study investigates 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. We enrolled 1664 adult subjects (mean age 62 years) affected mostly by COPD (52%) and asthma (42%). Respectively, 843 and 1113 patients were using MDIs and DPIs at home; of the latter, the users of Aerolizer®, Diskus®, HandiHaler® and Turbuhaler® were 82, 467, 505 and 361. We have a total of 2288 records of inhaler technique. Critical mistakes were widely distributed among users of all the inhalers, ranging from 12% for MDIs, 35% for Diskus® and HandiHaler® and 44% for Turbuhaler®. Independently of the inhaler, we found the strongest association between inhaler misuse and older age (p = 0.008), lower schooling (p = 0.001) and lack of instruction received for inhaler technique by health caregivers (p < 0.001). Inhaler misuse was associated with increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), courses of oral steroids (p < 0.001) and antimicrobials (p < 0.001) and poor disease control evaluated as an ACT score for the asthmatics (p < 0.0001) and the whole population (p < 0.0001). We conclude that inhaler mishandling continues to be common in experienced outpatients referring to chest clinics and associated with increased unscheduled health-care resource use and poor clinical control. Instruction by health caregivers is the only modifiable factor useful for reducing inhaler mishandling. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time?

            Problems with the use of inhalers by patients were noted shortly after the launch of the metered-dose inhaler (MDI) and persist today. We 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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              Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients.

              Acute exacerbations of chronic obstructive pulmonary disease (COPD) can be prevented by inhaled treatment. Errors in inhaler handling, not taken into account in clinical trials, could impact drug delivery and minimise treatment benefit. We aimed to assess real-life inhaler device handling in COPD patients and its association with COPD exacerbations.To this end, 212 general practitioners and 50 pulmonologists assessed the handling of 3393 devices used for continuous treatment of COPD in 2935 patients. Handling errors were observed in over 50% of handlings, regardless of the device used. Critical errors compromising drug delivery were respectively made in 15.4%, 21.2%, 29.3%, 43.8%, 46.9% and 32.1% of inhalation assessment tests with Breezhaler® (n=876), Diskus® (n=452), Handihaler® (n=598), pressurised metered-dose inhaler (pMDI) (n=422), Respimat® (n=625) and Turbuhaler® (n=420).The proportion of patients requiring hospitalisation or emergency room visits in the past 3 months for severe COPD exacerbation was 3.3% (95% CI 2.0-4.5) in the absence of error and 6.9% (95% CI 5.3-8.5) in the presence of critical error (OR 1.86, 95% CI 1.14-3.04, p<0.05).Handling errors of inhaler devices are underestimated in real life and are associated with an increased rate of severe COPD exacerbation. Training in inhaler use is an integral part of COPD management.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                copd
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                18 December 2020
                2020
                : 15
                : 3367-3373
                Affiliations
                [1 ]Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen , Aachen, Germany
                [2 ]Elsass Pharmacy , Aachen, Germany
                Author notes
                Correspondence: Tobias MüllerDepartment of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen , Pauwelsstrasse 30, Aachen52074, GermanyTel +49 241 80-89946Fax +49 241 80-82153 Email tobmueller@ukaachen.de
                Author information
                http://orcid.org/0000-0002-9801-3496
                Article
                279193
                10.2147/COPD.S279193
                7755880
                33376317
                424b1f2f-f3c7-4a43-8bc0-30eee0eacb09
                © 2020 Müller et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 04 September 2020
                : 06 November 2020
                Page count
                Figures: 2, Tables: 6, References: 24, Pages: 7
                Categories
                Original Research

                Respiratory medicine
                inhaler use,copd,asthma,training
                Respiratory medicine
                inhaler use, copd, asthma, training

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