Abstract
Introduction: Patient-inhalation device mismatch is unacceptably frequent in asthma and COPD. Considering that patient-device mismatch leads to reduced disease control, the aims of this study are to measure the prevalence of patient-device mismatch by using objective measurements and to identify patient characteristics associated with patient-device mismatch.Materials and methods: This cross-sectional study took place at the UZ Brussel’s respiratory outpatient clinic. Patients with asthma and COPD were recruited after the consultation with the pulmonologist. The intervention consisted of three steps. First, all patients performed a deep voluntary inspiration. Secondly, patients who used a pressurized metered dose inhaler (pMDI) demonstrated their inhaler technique through a placebo pMDI. If an incorrect coordination was performed, additional education was provided. Subsequently, in all patients, peak inspiratory flow (PIF) was measured with an In-check DIAL G16 device over 5 different resistances. The inspiration, coordination and PIF were each scored by pass or fail.
Results: One hundred and ninety-six patients participated in this study, 127 patients (65%) had asthma and 69 patients (35%) had COPD. Seventy-two patients (54%) demonstrated correct actuation-inhalation coordination with pMDI. After the additional education session, all achieved correct coordination. Almost all (97%) DPI users achieved minimal PIF, while 85% of the patients reached optimal PIF for their own device. Logistic regression analysis identified older age as a significant contributor to patient-device mismatch in patients with asthma using a DPI and in patients using a pMDI.
Conclusions: In almost half of the pMDI users, patient-device mismatch was identified at the initial assessment. The finding that an education session improves the proportion of patients achieving a correct coordination to a 100%, emphasizes the importance of a clear explanation of the inhaler technique with pMDI. Age is an independent and consistent contributor to patient-device mismatch, with both pMDI (coordination) in asthma and COPD, and with DPI (PIF) in asthma. When only limited resources are available, interventions to assess PIF prior to prescribing a DPI could focus on elderly
| Date of Award | 2022 |
|---|---|
| Original language | English |
| Supervisor | Eef Vanderhelst (Promotor) |