Changes in critical inhaler technique errors in inhaled COPD treatment – a one-year follow-up study in Sweden

Abstract

<b>Background:</b> Critical errors in inhaler technique have been associated with poor disease outcomes in chronic obstructive pulmonary disease (COPD) in studies with retrospective study design. We aimed to assess, correct and follow-up critical inhaler technique errors, and to investigate their association with COPD symptoms and exacerbations. <b>Methods:</b> COPD-diagnosed primary and secondary care outpatients (n=310) demonstrated inhaler technique with inhaler devices they were prescribed and currently using. Critical errors in opening, positioning and loading the inhaler device, and exhalation through dry-powder inhalers were assessed and corrected, and the assessment was repeated one year later. COPD Assessment Test score, the modified Medical Research Council dyspnoea scale score and exacerbation history were collected at both visits. <b>Results:</b> The proportion of patients making ≥ 1 critical inhaler technique error was lower at follow-up in the total population (46% vs 37%, p = 0.01) and among patients with unchanged device models (46% vs 35%, p = 0.02), but not among patients with a new inhaler device model (46% vs 41%, p = 0.56). Not positioning the device correctly was the most common critical error at both visits (30% and 22%). No association was found between critical errors and COPD symptoms or exacerbations.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Conclusions:</b> Assessment and correction of inhaler technique was associated with a decrease in critical inhaler technique errors. This effect was most pronounced in patients using the same device models throughout the follow-up period.