Document Detail


Inhaler mishandling remains common in real life and is associated with reduced disease control.
MedLine Citation:
PMID:  21367593     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Proper inhaler technique is crucial for effective management of asthma and COPD. This multicentre, cross-sectional, observational study investigates the prevalence of inhaler mishandling in a large population of experienced patients referring to chest clinics; to analyze the variables associated with misuse and the relationship between inhaler handling and health-care resources use and disease control. We enrolled 1664 adult subjects (mean age 62 years) affected mostly by COPD (52%) and asthma (42%). Respectively, 843 and 1113 patients were using MDIs and DPIs at home; of the latter, the users of Aerolizer®, Diskus®, HandiHaler® and Turbuhaler® were 82, 467, 505 and 361. We have a total of 2288 records of inhaler technique. Critical mistakes were widely distributed among users of all the inhalers, ranging from 12% for MDIs, 35% for Diskus® and HandiHaler® and 44% for Turbuhaler®. Independently of the inhaler, we found the strongest association between inhaler misuse and older age (p = 0.008), lower schooling (p = 0.001) and lack of instruction received for inhaler technique by health caregivers (p < 0.001). Inhaler misuse was associated with increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), courses of oral steroids (p < 0.001) and antimicrobials (p < 0.001) and poor disease control evaluated as an ACT score for the asthmatics (p < 0.0001) and the whole population (p < 0.0001). We conclude that inhaler mishandling continues to be common in experienced outpatients referring to chest clinics and associated with increased unscheduled health-care resource use and poor clinical control. Instruction by health caregivers is the only modifiable factor useful for reducing inhaler mishandling.
Authors:
Andrea S Melani; Marco Bonavia; Vincenzo Cilenti; Cristina Cinti; Marco Lodi; Paola Martucci; Maria Serra; Nicola Scichilone; Piersante Sestini; Maria Aliani; Margherita Neri;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2011-03-02
Journal Detail:
Title:  Respiratory medicine     Volume:  105     ISSN:  1532-3064     ISO Abbreviation:  Respir Med     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-04-25     Completed Date:  2011-06-30     Revised Date:  2012-05-02    
Medline Journal Info:
Nlm Unique ID:  8908438     Medline TA:  Respir Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  930-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Ltd. All rights reserved.
Affiliation:
Fisiopatologia e Riabilitazione Respiratoria, Policlinico Le Scotte, Azienda Ospedaliera Senese, Siena, Italy. a.melani@ao-siena.toscana.it
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Asthma / drug therapy*,  psychology
Cross-Sectional Studies
Female
Humans
Metered Dose Inhalers
Middle Aged
Patient Compliance / psychology,  statistics & numerical data*
Patient Education as Topic
Pulmonary Disease, Chronic Obstructive / drug therapy*,  psychology
Self Care
Investigator
Investigator/Affiliation:
Andrea Melani / ; Maria Aliani / ; Natalino Barbato / ; Marco Bonavia / ; Piero Aldo Canessa / ; Vicenzo Cilenti / ; Cristina Cinti / ; Vicenza Mariano / ; Franco Falcone / ; Isotta Coloretti / ; Mario Del Donno / ; Mario DelDonno / ; Renato DeTullio / ; Raffaela Giacobbe / ; Martucci Paola / ; Marco Lodi / ; Margherita Neri / ; Pietro Noceti / ; Franco Romano / ; Anna Rosa / ; Nicola Scichilone / ; Antonella Serafini / ; Maria Serra / ; Albino Sini / ; Adriano Vaghi / ; Ylli Vakefflliu / ; Vicenzo Zagà / ; Doriana Zanchetta /
Comments/Corrections
Erratum In:
Respir Med. 2012 May;106(5):757
Note: DelDonno, Mario [corrected to Del Donno, Mario]

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