Chest Infections SESSION TITLE: Respiratory Care SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 08:45 AM - 10:00 AM
Recent Inhaler Device Switch is Not Associated With Poor Inhaler Technique: Analysis of Inhaler Technique in the Adult Calgary COPD and Asthma Clinic Julia Pritchard* Alex Scurﬁeld and Brandie Walker University of Calgary, Calgary, AB, Canada PURPOSE: Inhaled medications are essential for the treatment of asthma and COPD. Poor inhaler technique is linked reduced asthma control, increased hospitalizations and exacerbation rates. Unfortunately, inhaler technique errors are common and rates of poor inhaler technique have not changed despite introduction of educational strategies. Previous research has identiﬁed risk factors associated with poor technique, such as, increased age, English as a second language (ESL), and multiple medical comorbidities. We hypothesized that with increasing types of devices available for use a recent device switch may be an emerging risk factor for persistently elevated inhaler error rates. METHODS: 95 adult newly referred patients to the COPD and Asthma Respiratory Education Program were assessed by a certiﬁed respiratory education. Baseline demographics and information on inhaler usage was obtained. Critical errors were deﬁned a priori. A patient was categorized as having inadequate inhaler technique if a critical error was identiﬁed.
RESULTS: The total rate of critical errors/inadequate inhaler technique amongst new referrals was 52.6% (95% CI 42.4%-62.9%). Lower MMRC score in patients with COPD (p=0.016) and ESL (p=0.031) were associated with inadequate inhaler technique. 39% of patients referred had a device switch in the last year. Patients with previously identiﬁed risk factors for poor inhaler technique such as increased age (p=0.064), vision impairment (0.027), no high school education (0.006), ESL (0.056), poor asthma control (0.041), and increased number of devices (0.005) were associated with a recent device switch. Overall, there was no evidence to suggest that recent device switch is associated with increased odds of inadequate technique (OR=0.92; 95% CI 0.37-2.28). Interestingly, patients with vision problems who had a recent device switch had lower odds of inadequate inhaler technique (OR = 0.06; 95% CI 0.001-0.74, p=0.007). CONCLUSIONS: This pilot study shows that rates of inhaler error remain unacceptably high. A recent device switch was associated with multiple previously identiﬁed risk factors for poor technique. However, a recent device switch itself does not seem to be a risk factor despite the fact that the patient is required to learn a new skill. In fact, in patients with speciﬁc risks (ex. visual impairment) a device switch may be protective. CLINICAL IMPLICATIONS: It is important to understand that inhaler error remains a critical issue in respiratory health. As there are increasing numbers of devices available patients are more likely to have a new inhaler device to learn. Further research to understand that role device selection to improve patient technique is needed. DISCLOSURE: The following authors have nothing to disclose: Julia Pritchard, Alex Scurﬁeld, Brandie Walker No Product/Research Disclosure Information DOI:
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
152#4S CHEST OCTOBER 2017