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      Objective Assessment of Patient Inhaler User Technique Using an Audio-Based Classification Approach

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          Abstract

          Many patients make critical user technique errors when using pressurised metered dose inhalers (pMDIs) which reduce the clinical efficacy of respiratory medication. Such critical errors include poor actuation coordination (poor timing of medication release during inhalation) and inhaling too fast (peak inspiratory flow rate over 90 L/min). Here, we present a novel audio-based method that objectively assesses patient pMDI user technique. The Inhaler Compliance Assessment device was employed to record inhaler audio signals from 62 respiratory patients as they used a pMDI with an In-Check Flo-Tone device attached to the inhaler mouthpiece. Using a quadratic discriminant analysis approach, the audio-based method generated a total frame-by-frame accuracy of 88.2% in classifying sound events (actuation, inhalation and exhalation). The audio-based method estimated the peak inspiratory flow rate and volume of inhalations with an accuracy of 88.2% and 83.94% respectively. It was detected that 89% of patients made at least one critical user technique error even after tuition from an expert clinical reviewer. This method provides a more clinically accurate assessment of patient inhaler user technique than standard checklist methods.

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          Most cited references37

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          Statistical pattern recognition: a review

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            Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes.

            Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes.
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              Importance of inhaler devices in the management of airway disease.

              The delivery of drugs by inhalation is an integral component of asthma and chronic obstructive pulmonary disease (COPD) management. However, even with effective inhaled pharmacological therapies, asthma, particularly, remains poorly controlled around the world. The reasons for this are manifold, but limitations of treatment guidelines in terms of content, implementation and relevance to everyday clinical life, including insufficient patient education, access to health care and cost of medication as well as poor inhaler technique are likely to contribute. Considering that inhalation therapy is a cornerstone in asthma and COPD management, little advice is provided in the guidelines regarding inhaler selection. The pressurised metered dose inhaler (pMDI) is still the most frequently prescribed device worldwide, but even after repeated tuition many patients fail to use it correctly. In addition, the correct technique can be lost over time. Although several improvements in pMDIs such as a change in the propellant and actuation have resulted in improvements in lung deposition, many dry powder inhalers (DPIs) are easier to use. However, these devices also have limitations such as dependency of drug particle size on flow rate and loss of the metered dose if the patient exhales through the device before inhaling. Improvements in using inhalation devices more efficiently, in inhaler design for supporting patient compliance, and advances in inhaler technology to assure drug delivery to the lungs, have the potential to improve asthma and COPD management and control. New and advanced devices are considered being helpful to minimise the most important problems patients have with current DPIs.
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                Author and article information

                Contributors
                taylorte@tcd.ie
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                1 February 2018
                1 February 2018
                2018
                : 8
                : 2164
                Affiliations
                [1 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, Trinity Centre for Bioengineering, Trinity College, The University of Dublin, ; Dublin, Ireland
                [2 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, School of Engineering, Trinity College, The University of Dublin, ; Dublin, Ireland
                [3 ]ISNI 0000 0004 1937 0511, GRID grid.7489.2, Department of Biomedical Engineering, , Ben-Gurion University of the Negev, ; Beer-Sheva, Israel
                [4 ]ISNI 0000 0004 0488 7120, GRID grid.4912.e, Department of Medicine, , Royal College of Surgeons in Ireland, ; Dublin, Ireland
                [5 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, School of Medicine, Trinity College, The University of Dublin, ; Dublin, Ireland
                Author information
                http://orcid.org/0000-0001-8578-1245
                Article
                20523
                10.1038/s41598-018-20523-w
                5794789
                29391489
                e5cb4d01-a8dd-4517-b1fc-00f2b3adf34b
                © The Author(s) 2018

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 19 September 2017
                : 16 January 2018
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