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      Medication Errors in Adolescents Using Asthma Controller Medications

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      Author(s): , Pharm D 1 , , PhD 1 , , MD 2 , , PhD 1 , , MS 1 , , PhD 1
      Publication date (Electronic):
      Journal: Global Pediatric Health
      Publisher: SAGE Publications
      Keywords: asthma, adolescents, medication error

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          Abstract

          The purpose of this study was to describe the number and types of errors that adolescents and caregivers report making when using asthma controller medications. A total of 319 adolescents ages 11 to 17 with persistent asthma and their caregivers participated in this cross-sectional study. Adolescent and caregiver reports of asthma medication use were compared to the prescribed directions in the medical record. An error was defined as discrepancies between reported use and the prescribed directions. About 38% of adolescents reported 1 error in using asthma controller medications, 16% reported 2 errors, and 5% reported 3 or more errors. About 42% of caregivers reported 1 error in adolescents using asthma controller medications, 14% reported 2 errors, while 6% reported 3 or more errors. The type of error most frequently reported by both was not taking the medication at all. Providers should ask open-ended questions of adolescents with asthma during visits so they can detect and educate families on how to overcome errors in taking controller medication use.

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

          Andrea Melani, Marco Bonavia, Vincenzo Cilenti … (2011)
          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.
          Article 0 comments Cited 119 times – based on 0 reviews     Review now
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            Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients.

            Pierre-Olivier Girodet, Nicholas Moore, Anais Chartier … (2017)
            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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              Barriers to treatment adherence for children with cystic fibrosis and asthma: what gets in the way?

              Avani C. Modi, Alexandra L Quittner (2006)
              The purpose of this study was to systematically identify barriers to treatment adherence for children with cystic fibrosis (CF) and asthma, as well as to examine the relationship between the number of barriers and adherence. Participants included 73 children with CF or asthma and their parents. The mean age of the sample was 9.9 years, and 58% were males. Results indicated that barriers were quite similar by illness and informant (e.g., parent and child) for the same treatments, but unique barriers were identified for disease-specific treatments. Frequently mentioned barriers across diseases included forgetting, oppositional behaviors, and difficulties with time management. Trends were identified between adherence and barriers, suggesting that a greater number of barriers were related to poorer adherence. Overall, this study provided evidence that patients and their parents experience specific barriers within the context of their own illness and highlights the need for disease-specific measures and interventions.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Glob Pediatr Health
                Journal ID (iso-abbrev): Glob Pediatr Health
                Journal ID (publisher-id): GPH
                Journal ID (hwp): spgph
                Title: Global Pediatric Health
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Electronic): 2333-794X
                Publication date (Electronic): 14 December 2020
                Publication date Collection: 2020
                Volume: 7
                Electronic Location Identifier: 2333794X20981341
                Affiliations
                [1 ]University of North Carolina, Chapel Hill, NC, USA
                [2 ]Boston Children’s Hospital, Boston, MA, USA
                Author notes
                [*]Betsy Sleath, UNC Eshelman School of Pharmacy, University of North Carolina, CB# 7573, Chapel Hill, NC 27599-7573, USA. Email: betsy_sleath@ 123456unc.edu
                Author information
                https://orcid.org/0000-0001-6593-9850
                https://orcid.org/0000-0002-8861-6955
                Article
                Publisher ID: 10.1177_2333794X20981341
                DOI: 10.1177/2333794X20981341
                PMC ID: 7739079
                SO-VID: 983c2747-b56f-434b-b226-0afdfb555828
                Copyright © © The Author(s) 2020
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 28 July 2020
                Date revision received : 4 November 2020
                Date accepted : 24 November 2020
                Funding
                Funded by: Patient-Centered Outcomes Research Institute, FundRef https://doi.org/10.13039/100006093;
                Award ID: 1402-09777
                Funded by: National Center for Advancing Translational Sciences, FundRef https://doi.org/10.13039/100006108;
                Award ID: 1UL1TR001111
                Categories
                Subject: Original Article
                Custom metadata
                cover-date January-December 2020
                typesetter ts1

                Keywords: asthma,adolescents,medication error
                Data availability:
                Keywords: asthma, adolescents, medication error

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