Inhaler devices in asthma and COPD - An assessment of inhaler technique and patient preferences

Background: Incorrect use of inhaler devices remains an obstacle for respiratory diseases management. We aimed to evaluate the frequency of inhaler technique errors; to determine the devices perceived as the easiest and favourite to use; to study the association of device type, demographics and patient preferences with inhaler technique (IT). Methods: Cross-sectional assessment of 301 adults, with asthma (194) or chronic pulmonary obstructive disease, undergoing treatment with Aerolizer((R)), Autohaler((R)), Breezehaler((R)), Diskus((R)), Handihater((R)), MDI without spacer, Miat-haler((R)), Novolizer((R)), Respimat((R)) and/or Turbohaler((R)). Patients completed self-assessment questionnaires and face-to-face interview, with demonstration of inhaler technique. The rate of wrong steps (number of wrong steps divided by number of total steps; RWS) was the primary outcome. Adjusted odds ratio (aOR) (95% confidence intervals [Cl]) for presenting >=1 IT errors were computed. Results: From the 464 inhaler technique performances, the median RWS was 18%. Turbohaler((R)) (21%) and Diskus((R)) (19%) were chosen as easiest and Novolizer((R)) (18%), Diskus((R)) (18%), Turbohaler((R)) (17%) as favourite for daily use. Females (aOR 2.68 [95% CI 1.55-4.65]; vs. males], patients with >64 yr (aOR 2.73 [95% CI 1.15-6.48]; vs <45 yr) and patients using Aerolizer or Handihaler (aOR 3.24 [95% CI 1.13-9.32] and aOR 3.71 [95% CI 1.38-10.2], respectively) were more likely to perform IT errors; otherwise, no association was found, including with using the favourite device (aOR 1.43 [95% CI 0.84-2.42]). Conclusion: The frequency of inhaler technique errors was high and no device was clearly preferred over the others. Using the preferred inhaler device was not associated with less errors. (C) 2014 Elsevier Ltd. All rights reserved.