Metered Dose Inhaler Errors Affect Many With COPD and Asthma

inhalers asthma COPD
The most common error related to the use of metered dose inhalers was the failure to attach the inhaler to a spacer.

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — In the United States, two-thirds of adults diagnosed with chronic obstructive pulmonary disease (COPD) or asthma reported metered dose inhaler errors, indicating the importance of educating patients on inhaler technique and selecting the right device. This research was presented at the CHEST Annual Meeting, held October 6-10, 2018, in San Antonio, Texas.

Researchers of this meta-analysis sought to estimate overall and step-by-step errors related to the use of metered dose inhalers in US adult populations with COPD or asthma.

They performed a systematic review of studies accessed from relevant databases (PubMed, EMBASE, PsycINFO, Cochrane, and Google Scholar) that mentioned inhaler-related errors reported in patients diagnosed with COPD or asthma. Independent reviewers graded the quality of each study and extracted data on sociodemographic and clinical characteristics and overall and step-by-step metered dose inhaler errors. The researchers calculated the proportion of patients who experienced overall device errors (defined as error in ≥20%  of the inhaler steps) as well as step-by-step errors. A meta-analysis estimated mean effect size for overall and step-by-step errors across all studies, and random-effects models were used to calculate weighted or pooled estimates.

A total of 8 studies with 1198 participants were identified in which the weighted mean error rate for metered dose inhalers overall was 66.5% (95% CI, 52.8-80.1). In addition, 5 studies (n=857) provided step-by-step errors and attributed the most common as failure to attach the inhaler to a spacer (73.8% of errors; 95% CI, 67.9-79.7), failure to exhale fully and away before using the inhaler (68.7% of errors; 95% CI, 47.3-90.2), failure to inhale slowly and deeply (47.8% of errors; 95% CI, 30.0-65.4), failure to hold breath for 5 to 10 seconds (40.1% of errors; 95% CI, 23.9-56.3), and failure to shake the inhaler before use (37.9% of errors; 95% CI, 33.5-42.3). Using I2 statistics to measure heterogeneity, the researchers suggested that the generalizability of the findings was acceptable (I2=6.8).

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In adults with COPD or asthma, two-thirds reported errors related to metered dose inhaler use. In reported step-by-step errors, ≥40% of patients failed to exhale fully and away prior to inhalation, to inhale slowly and deeply, or to hold their breath for a full 5 to 10 seconds. The findings of this review indicate the importance of educating patients on inhaler technique. Many of the step-by-step errors are preventable by using nebulized therapy instead of a metered dose inhaler device.

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please see full reference for a complete list of authors’ disclosures.

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Navaie M, Ganapathy V, Cho-Reyes S, Celli B, Dembek C, Yeh K. Inhalation device technique errors among patients with obstructive lung disease using metered-dose inhalers: a systematic review and meta-analysis of US studies. Presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio, TX.