Abstract
Inhaled medications are critical in the pharmaceutical management of respiratory conditions, however, the majority of patients demonstrate at least one critical error when using an inhaler. Since community pharmacists can be instrumental in addressing this care gap, we aimed to determine the rate and type of critical inhaler errors in community pharmacy settings, elucidate the factors contributing to inhaler technique errors, and identify instances when community pharmacists check proper inhaler use. Fourth year pharmacy students on community practice placement (n = 53) identified 200 patients where at least one error was observed in 78% of participants when demonstrating inhaler technique. Prevalent errors of the users were associated with metered dose inhaler (MDI) (55.6%), Ellipta® (88.3%), and Discus® (86.7%) devices. Overall, the mean number of errors was 1.09. Possession of more than one inhaler, use of rescue inhaler, and poor control of asthma were found to be significant predictors of having at least one critical error. In all participating pharmacies, inhaler technique is mainly checked on patient request (93.0%) and for all new inhalers (79.0%).
Highlights
Inhaled medications are critical in the pharmaceutical management of respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD)
Some critical errors were not addressed in previous studies such as not using a spacer with a metered dose inhaler (MDI), not checking to see whether the device was empty, touching the capsule with fingers when removing it from the device, or errors associated with devices that were not included in those studies (e.g., Ellipta®, Respimat® )
Studies that did not provide data on specific errors for the studied inhalers [14,34] reported that MDIs, Turbuhaler®, and Discus® had the most prevalent critical errors, which is consistent with our findings
Summary
Inhaled medications are critical in the pharmaceutical management of respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Up to 92% of patients demonstrate at least one critical error when using an inhaler, which can lead to decreased effectiveness of the inhaled drug [1]. Inhaler technique has not improved in the past 40 years [2]. This lack of progress is likely compounded by recent advances in inhaler technologies, which has resulted in a plethora of marketed inhaler devices [3]. Each device requires a different inhalation technique to enable optimal drug delivery to the lungs. Patients who make inhaler technique errors exhibit decreased serum drug levels [4]. Inhaler technique errors have been associated with uncontrolled asthma as well as increased rates of severe COPD exacerbations [5,6,7]. Poor inhalation technique leads to increased healthcare utilization and costs [8,9]
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