Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD?: Findings from the cross-sectional observational MISMATCH study

Lars Dijk; Marjan Kerkhof; Merijn Driessen; Yoran H. Gerritsma; Sinthia Bosnic-Anticevich; Jaime Correia-De-Sousa; P. N. Richard Dekhuijzen; Marika Leving; David B. Price; Ioanna Tsiligianni; Omar Usmani; Huib A. M. Kerstjens; Janwillem W. H. Kocks

doi:10.1136/bmjresp-2023-001821

Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD? Findings from the cross-sectional observational MISMATCH study

Lars Dijk, Marjan Kerkhof, Merijn Driessen, Yoran H. Gerritsma, Sinthia Bosnic-Anticevich, Jaime Correia-De-Sousa, P. N. Richard Dekhuijzen, Marika Leving, David B. Price, Ioanna Tsiligianni, Omar Usmani, Huib A. M. Kerstjens, Janwillem W. H. Kocks^*

^*Corresponding author for this work

Macquarie Medical School

Research output: Contribution to journal › Article › peer-review

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Abstract

Background Patients with chronic obstructive pulmonary disease (COPD) may be prescribed multiple inhalers that require different techniques for optimal performance. Mixing devices has been associated with poorer COPD outcomes suggesting that it leads to inappropriate inhaler technique. However, empirical evidence is lacking. Aims Compare the nature and frequency of dry powder inhaler (DPI) technique errors in patients with COPD using (1) a single DPI or (2) mixed-devices (a DPI and pressurised metered dose inhaler (pMDI)). Methods Data from the PIFotal study-a cross-sectional study on Peak Inspiratory Flow in patients with COPD using a DPI as maintenance therapy, capturing data from 1434 patients on demographic characteristics, COPD health status and inhaler technique-were used to select 291 patients using mixed-devices. Frequency matching based on country of residence and DPI device type was used to select 291 patients using a DPI-only for comparison. Predetermined checklists were used for the evaluation of DPI video recordings and complemented with additional errors that were observed in ≥10%. Error proportions were calculated for the (1) individual and total number of errors, (2) number of critical errors and (3) number of pMDI-related errors. Results The study sample contained 582 patients (mean (SD) age 69.6 (9.4) years, 47.1% female). DPI technique errors were common, but not significantly different between the groups. The majority of patients made at least one critical error (DPI-only: 90.7% vs mixed-devices: 92.8%). Proportions of total, 'pMDI-related' and critical errors did not significantly differ between the groups. Conclusion The nature and frequency of inhaler technique errors did not substantially differ between patients prescribed with a single DPI and mixed-devices. Currently, 'pMDI-related errors' in DPI use are not accounted for in existing checklists.

Trial registration number ENCEPP/EUPAS48776.

Original language	English
Article number	e001821
Pages (from-to)	1-11
Number of pages	11
Journal	BMJ Open Respiratory Research
Volume	10
Issue number	1
DOIs	https://doi.org/10.1136/bmjresp-2023-001821
Publication status	Published - 22 Dec 2023

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Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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Dijk, L., Kerkhof, M., Driessen, M., Gerritsma, Y. H., Bosnic-Anticevich, S., Correia-De-Sousa, J., Dekhuijzen, P. N. R., Leving, M., Price, D. B., Tsiligianni, I., Usmani, O., Kerstjens, H. A. M., & Kocks, J. W. H. (2023). Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD? Findings from the cross-sectional observational MISMATCH study. BMJ Open Respiratory Research, 10(1), 1-11. Article e001821. https://doi.org/10.1136/bmjresp-2023-001821

@article{6704f614f40e469e8c5993c139576f37,

title = "Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD?: Findings from the cross-sectional observational MISMATCH study",

abstract = "Background Patients with chronic obstructive pulmonary disease (COPD) may be prescribed multiple inhalers that require different techniques for optimal performance. Mixing devices has been associated with poorer COPD outcomes suggesting that it leads to inappropriate inhaler technique. However, empirical evidence is lacking. Aims Compare the nature and frequency of dry powder inhaler (DPI) technique errors in patients with COPD using (1) a single DPI or (2) mixed-devices (a DPI and pressurised metered dose inhaler (pMDI)). Methods Data from the PIFotal study-a cross-sectional study on Peak Inspiratory Flow in patients with COPD using a DPI as maintenance therapy, capturing data from 1434 patients on demographic characteristics, COPD health status and inhaler technique-were used to select 291 patients using mixed-devices. Frequency matching based on country of residence and DPI device type was used to select 291 patients using a DPI-only for comparison. Predetermined checklists were used for the evaluation of DPI video recordings and complemented with additional errors that were observed in ≥10\%. Error proportions were calculated for the (1) individual and total number of errors, (2) number of critical errors and (3) number of pMDI-related errors. Results The study sample contained 582 patients (mean (SD) age 69.6 (9.4) years, 47.1\% female). DPI technique errors were common, but not significantly different between the groups. The majority of patients made at least one critical error (DPI-only: 90.7\% vs mixed-devices: 92.8\%). Proportions of total, 'pMDI-related' and critical errors did not significantly differ between the groups. Conclusion The nature and frequency of inhaler technique errors did not substantially differ between patients prescribed with a single DPI and mixed-devices. Currently, 'pMDI-related errors' in DPI use are not accounted for in existing checklists.Trial registration number ENCEPP/EUPAS48776.",

author = "Lars Dijk and Marjan Kerkhof and Merijn Driessen and Gerritsma, \{Yoran H.\} and Sinthia Bosnic-Anticevich and Jaime Correia-De-Sousa and Dekhuijzen, \{P. N. Richard\} and Marika Leving and Price, \{David B.\} and Ioanna Tsiligianni and Omar Usmani and Kerstjens, \{Huib A. M.\} and Kocks, \{Janwillem W. H.\}",

note = "Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2023",

month = dec,

day = "22",

doi = "10.1136/bmjresp-2023-001821",

language = "English",

volume = "10",

pages = "1--11",

journal = "BMJ Open Respiratory Research",

issn = "2052-4439",

publisher = "BMJ Publishing Group",

number = "1",

}

Dijk, L, Kerkhof, M, Driessen, M, Gerritsma, YH, Bosnic-Anticevich, S, Correia-De-Sousa, J, Dekhuijzen, PNR, Leving, M, Price, DB, Tsiligianni, I, Usmani, O, Kerstjens, HAM & Kocks, JWH 2023, 'Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD? Findings from the cross-sectional observational MISMATCH study', BMJ Open Respiratory Research, vol. 10, no. 1, e001821, pp. 1-11. https://doi.org/10.1136/bmjresp-2023-001821

TY - JOUR

T1 - Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD?

T2 - Findings from the cross-sectional observational MISMATCH study

AU - Dijk, Lars

AU - Kerkhof, Marjan

AU - Driessen, Merijn

AU - Gerritsma, Yoran H.

AU - Bosnic-Anticevich, Sinthia

AU - Correia-De-Sousa, Jaime

AU - Dekhuijzen, P. N. Richard

AU - Leving, Marika

AU - Price, David B.

AU - Tsiligianni, Ioanna

AU - Usmani, Omar

AU - Kerstjens, Huib A. M.

AU - Kocks, Janwillem W. H.

N1 - Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2023/12/22

Y1 - 2023/12/22

N2 - Background Patients with chronic obstructive pulmonary disease (COPD) may be prescribed multiple inhalers that require different techniques for optimal performance. Mixing devices has been associated with poorer COPD outcomes suggesting that it leads to inappropriate inhaler technique. However, empirical evidence is lacking. Aims Compare the nature and frequency of dry powder inhaler (DPI) technique errors in patients with COPD using (1) a single DPI or (2) mixed-devices (a DPI and pressurised metered dose inhaler (pMDI)). Methods Data from the PIFotal study-a cross-sectional study on Peak Inspiratory Flow in patients with COPD using a DPI as maintenance therapy, capturing data from 1434 patients on demographic characteristics, COPD health status and inhaler technique-were used to select 291 patients using mixed-devices. Frequency matching based on country of residence and DPI device type was used to select 291 patients using a DPI-only for comparison. Predetermined checklists were used for the evaluation of DPI video recordings and complemented with additional errors that were observed in ≥10%. Error proportions were calculated for the (1) individual and total number of errors, (2) number of critical errors and (3) number of pMDI-related errors. Results The study sample contained 582 patients (mean (SD) age 69.6 (9.4) years, 47.1% female). DPI technique errors were common, but not significantly different between the groups. The majority of patients made at least one critical error (DPI-only: 90.7% vs mixed-devices: 92.8%). Proportions of total, 'pMDI-related' and critical errors did not significantly differ between the groups. Conclusion The nature and frequency of inhaler technique errors did not substantially differ between patients prescribed with a single DPI and mixed-devices. Currently, 'pMDI-related errors' in DPI use are not accounted for in existing checklists.Trial registration number ENCEPP/EUPAS48776.

AB - Background Patients with chronic obstructive pulmonary disease (COPD) may be prescribed multiple inhalers that require different techniques for optimal performance. Mixing devices has been associated with poorer COPD outcomes suggesting that it leads to inappropriate inhaler technique. However, empirical evidence is lacking. Aims Compare the nature and frequency of dry powder inhaler (DPI) technique errors in patients with COPD using (1) a single DPI or (2) mixed-devices (a DPI and pressurised metered dose inhaler (pMDI)). Methods Data from the PIFotal study-a cross-sectional study on Peak Inspiratory Flow in patients with COPD using a DPI as maintenance therapy, capturing data from 1434 patients on demographic characteristics, COPD health status and inhaler technique-were used to select 291 patients using mixed-devices. Frequency matching based on country of residence and DPI device type was used to select 291 patients using a DPI-only for comparison. Predetermined checklists were used for the evaluation of DPI video recordings and complemented with additional errors that were observed in ≥10%. Error proportions were calculated for the (1) individual and total number of errors, (2) number of critical errors and (3) number of pMDI-related errors. Results The study sample contained 582 patients (mean (SD) age 69.6 (9.4) years, 47.1% female). DPI technique errors were common, but not significantly different between the groups. The majority of patients made at least one critical error (DPI-only: 90.7% vs mixed-devices: 92.8%). Proportions of total, 'pMDI-related' and critical errors did not significantly differ between the groups. Conclusion The nature and frequency of inhaler technique errors did not substantially differ between patients prescribed with a single DPI and mixed-devices. Currently, 'pMDI-related errors' in DPI use are not accounted for in existing checklists.Trial registration number ENCEPP/EUPAS48776.

UR - https://www.scopus.com/pages/publications/85181177134

U2 - 10.1136/bmjresp-2023-001821

DO - 10.1136/bmjresp-2023-001821

M3 - Article

C2 - 38135462

AN - SCOPUS:85181177134

SN - 2052-4439

VL - 10

SP - 1

EP - 11

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

IS - 1

M1 - e001821

ER -

Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD? Findings from the cross-sectional observational MISMATCH study

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