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      Inhaler Technique and Self-reported Adherence to Medications Among Hospitalised People with Asthma and COPD

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      Drugs - Real World Outcomes
      Springer International Publishing

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          Abstract

          Background

          Metered dose inhalers (MDIs) and dry powder inhalers (DPIs) are devices used for the treatment of asthma and chronic obstructive pulmonary disease (COPD). Inhaler technique is important since incorrect technique can lead to a poorer prognosis and hospitalization.

          Objective

          The objective of this study was to investigate the inhaler technique and overall adherence to medications in an adult population with asthma and COPD.

          Patients and Methods

          Those invited to participate were people admitted to Umeå University Hospital in northern Sweden in October, November and December 2018, with inhaled medication prescribed prior to admission. Inhaler technique was assessed using checklists and observations with placebo-inhalers were conducted. The Medication Adherence Report Scale (MARS)-5 was used to measure self-reported overall adherence to drug medication.

          Results

          Of the 23 people included in the study, 26.1% had one or more critical errors in inhaler technique and 30.4% were considered overall non-adherent to drug medication. Among the 23 participants, the mean age, and the number of regularly prescribed medications were higher among those with poor inhaler technique than among people with no error in their inhaler technique.

          Conclusion

          This study indicates that poor inhaler technique and overall non-adherence to medications occur among hospitalised people with asthma and COPD living in northern Sweden. Interventions to improve inhaler technique and adherence to drugs are needed.

          Electronic supplementary material

          The online version of this article (10.1007/s40801-020-00210-x) contains supplementary material, which is available to authorized users.

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          Most cited references31

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          Global and regional estimates of COPD prevalence: Systematic review and meta–analysis

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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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              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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                Author and article information

                Contributors
                maria.gustafsson@umu.se
                Journal
                Drugs Real World Outcomes
                Drugs Real World Outcomes
                Drugs - Real World Outcomes
                Springer International Publishing (Cham )
                2199-1154
                2198-9788
                14 October 2020
                14 October 2020
                December 2020
                : 7
                : 4
                : 317-323
                Affiliations
                GRID grid.12650.30, ISNI 0000 0001 1034 3451, Department of Integrative Medical Biology, , Umeå University, ; 90187 Umeå, Sweden
                Author information
                http://orcid.org/0000-0003-3615-4880
                Article
                210
                10.1007/s40801-020-00210-x
                7581666
                33052539
                f99b5d59-bc1c-4698-b91d-a14d9d4571fb
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial 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 licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence 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 licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Funding
                Funded by: Swedish Pharmaceutical Society
                Categories
                Original Research Article
                Custom metadata
                © The Author(s) 2020

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