Inhaler use in chronic obstructive pulmonary disease patients: a meta-analysis†

Abstract

Abstract Objective: To evaluate errors in the use of inhalation techniques in patients with chronic obstructive pulmonary disease (COPD), and to provide evidence for improving the effectiveness of drugs. Methods: A meta-analysis was performed after searching for literature at PubMed, Embase, Web of Science, Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), WanFang, VIP, and SionMed databases which were published from January 2011 to October 2020, addressing errors in the use of inhalation technologies for the treatment of COPD. After reviewing the literature, extracting pertinent information, and evaluating the risk of bias for the included studies, statistical analysis was performed using Stata 15.1. Results: Thirteen papers (12 in English and 1 in Chinese), representing 2527 patients, met the search criteria and were included in the meta-analysis. The results showed that the combined effect size of COPD patients making at least one operational error was 76% (95% CI: 0.69–0.83). The error rate varied with inhaler type; the combined effect size error for powered inhalers was 66% (95% CI: 0.57, 0.74), 67% (95% CI. 0.57, 0.77) for metered-dose inhalers (MDI), and 51% (95% CI: 0.38, 0.64) for soft mist inhalers (SMI). Conclusions: More than 75% of patients with COPD were unable to consistently use inhalers correctly, with the highest error rate for MDI. Therefore, health care providers must continue to educate patients on proper use of inhaler, ensuring their correct use and reducing the risk of acute COPD exacerbations.