Abstract
Many patients make critical user technique errors when using pressurised metered dose inhalers (pMDIs) which reduce the clinical efficacy of respiratory medication. Such critical errors include poor actuation coordination (poor timing of medication release during inhalation) and inhaling too fast (peak inspiratory flow rate over 90 L/min). Here, we present a novel audio-based method that objectively assesses patient pMDI user technique. The Inhaler Compliance Assessment device was employed to record inhaler audio signals from 62 respiratory patients as they used a pMDI with an In-Check Flo-Tone device attached to the inhaler mouthpiece. Using a quadratic discriminant analysis approach, the audio-based method generated a total frame-by-frame accuracy of 88.2% in classifying sound events (actuation, inhalation and exhalation). The audio-based method estimated the peak inspiratory flow rate and volume of inhalations with an accuracy of 88.2% and 83.94% respectively. It was detected that 89% of patients made at least one critical user technique error even after tuition from an expert clinical reviewer. This method provides a more clinically accurate assessment of patient inhaler user technique than standard checklist methods.
Highlights
Inhalers are handheld devices used to deliver medication directly to the airways to treat asthma and COPD
Two of the most common critical errors patients make while using pressurised metered dose inhalers (pMDIs) include poor actuation coordination and inhaling too fast with a peak inspiratory flow rate (PIFR) of over 90 L/min[12,17,18,19]
Studies have reported that 45% of patients have poor actuation coordination while using a pMDI12
Summary
The pressurised metered dose inhaler (pMDI) is the most commonly used inhaler worldwide with total worldwide sales in excess of $2 billion per year[6,7] It is a handheld, cheap, multi-dose, portable device that is available for a number of medications[6]. Patient inhaler user technique is assessed most commonly using checklists based on visual/aural assessment by a healthcare professional[20,21] This method of assessment is subjective, it gives equal rating to all errors, is prone to overestimate patient performance and cannot be used to monitor how patients use their inhaler outside of clinical visits[22,23]. Many training devices, such as the Flo-Tone, cannot objectively monitor both actuation coordination and inhalation flow rate
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