Inhaler device and errors

Henry Crystyn

Inhalation errors have a significant impact on the disease control of asthma and chronic obstructive pulmonary disease (Melani AS et al. Respir Med. 2011;105(6):930-8; Al-Jahdali H et al; Allergy Asthma Clin Immunol. 2013;9(1):8. Westerik JA et al; J Asthma. 2016;53(3):321-329) with resultant economic burdens on the health care costs (Lewis A et al. BMC Health Serv Res. 2016; Jul 12, 16:251). The type and incidence of these errors has not changed over the past 40 years (Sanchis J et al. Chest. 2016;150(2):394-406). Analysis of published inhaler errors highlights that these can be categorised into dose preparation and inhalation manoeuvre errors. These categories are all generic for metered dose inhalers. Inhalation manoeuvre procedures are also generic errors when using dry powder inhalers whereas dose preparation steps are device specific. The CritiKal study, carried out throughout Western Europe and in Australia, examined inhaler errors and the level of asthma control in 3660 patients. This study has identified which inhalation technique errors are clinically significant. Also new in-vitro methods of identifying dose emission using patient inhalation profiles (Chrystyn H et al. Int J Pharm. 2015;491(12):268-76) are providing useful information about formulations that are not affected by how the patient inhales. Furthermore newer inhalers are now designed so that they are more intuitive to use. These latest contributions to the literature should direct healthcare professionals’ counselling sessions when choosing an inhaler for a patient and training them how to use it.

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