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. 2018 Jan 16;19(1):10.
doi: 10.1186/s12931-017-0710-y.

Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes

Omar Sharif Usmani  1 , Federico Lavorini  2 , Jonathan Marshall  3 , William Christopher Nigel Dunlop  3 , Louise Heron  4 , Emily Farrington  4 , Richard Dekhuijzen  5
Affiliations

Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes

Omar Sharif Usmani et al. Respir Res. .

Abstract

Background: Inhaled drug delivery is the cornerstone treatment for asthma and chronic obstructive pulmonary disease (COPD). However, use of inhaler devices can be challenging, potentially leading to critical errors in handling that can significantly reduce drug delivery to the lungs and effectiveness of treatment.

Methods: A systematic review was conducted to define 'critical' errors and their impact on health outcomes and resource use between 2004 and 2016, using key search terms for inhaler errors in asthma and COPD (Search-1) and associated health-economic and patient burden (Search-2).

Results: Search-1 identified 62 manuscripts, 47 abstracts, and 5 conference proceedings (n = 114 total). Search-2 identified 9 studies. We observed 299 descriptions of critical error. Age, education status, previous inhaler instruction, comorbidities and socioeconomic status were associated with worse handling error frequency. A significant association was found between inhaler errors and poor disease outcomes (exacerbations), and greater health-economic burden.

Conclusions: We have shown wide variations in how critical errors are defined, and the evidence shows an important association between inhaler errors and worsened health outcomes. Given the negative impact diminished disease outcomes impose on resource use, our findings highlight the importance of achieving optimal inhaler technique, and a need for a consensus on defining critical and non-critical errors.

Keywords: Adherence; Aerosols; Errors; Inhalers; Obstructive lung diseases.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

In the last 5 years, Omar S. Usmani and/or his department received research grants, unrestricted educational grants, and/or fees for lectures and advisory board meetings from Aerocrine, Astra Zeneca, Boehringer Ingelheim, Chiesi, Cipla, Edmond Pharma, GlaxoSmithKline, Napp, Mundipharma International, Prosonix, Sandoz, Takeda, Zentiva.

In the last 5 years, Federico Lavorini received fees for lectures and advisory board meetings from Astra Zeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini International, TEVA, Zentiva.

In the last 3 years, Richard Dekhuijzen and/or his department received research grants, unrestricted educational grants, and/or fees for lectures and advisory board meetings from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Mundipharma International, Novartis, Takeda and Teva.

William Dunlop and Jonathan Marshall are employees of Mundipharma International Ltd., United Kingdom.

Emily Farrington and Louise Heron are employees of Adelphi Values Ltd., UK. Adelphi Values Ltd. received funding from Mundipharma International Ltd. to support this research.

The authors do not report any conflict of interest with regards to the contents of this study other than those stated.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA diagram. The database search and analysis in Search-1 initially yielded 114 full-text articles or abstracts; give abstracts were removed and incorporated into the results of Search-2 due to being economics-focused; a further five abstracts were added to Search-1 following the grey literature search. Therefore, the final yield of Search-1 was 114
Fig. 2
Fig. 2
a. Journal articles reporting critical inhaler errors for pMDIs and DPIs. Note: percentages are calculated as a proportion of total mentions (n = 105) of each inhaler type by all inhaler error studies. Individual studies may mention more than one inhaler type. b. Journal articles reporting critical inhaler errors for specific DPI device types, both multi-dose (blue) and single-dose (red). Note: percentages are calculated as a proportion of total mentions (n = 65) of all device types by all inhaler error studies. Individual studies may mention more than one inhaler type. c. Studies stating a definition of a critical error, separated into categories. Details of each study and the exact wording used by each are presented in Additional file 1: Table S4. Note: In this figure the term “critical error” refers to both critical errors and critical steps that, when performed incorrectly, constitute critical errors
See this image and copyright information in PMC

References

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