A Study to Investigate the Prevalence of Device-Specific Errors in Inhaler Technique in Adults With Airway Disease (The SCORES Study): Protocol for a Single Visit Prevalence Study

Ruth De Vos, Thomas Brown, Jayne Longstaff, Mitch Lomax, Heather Mackenzie, Alexander Hicks, Hitasha Rupani, Jessica Gates, Lauren Fox, Laura Wiffen, Anoop J Chauhan, Ruth De Vos, Thomas Brown, Jayne Longstaff, Mitch Lomax, Heather Mackenzie, Alexander Hicks, Hitasha Rupani, Jessica Gates, Lauren Fox, Laura Wiffen, Anoop J Chauhan

Abstract

Background: It is a recurring theme in clinical practice that patients using inhaled medications via an inhaler do not use their device to a standard that allows for optimum therapeutic effect, and some studies have shown that up to 90% of people do not use their inhalers properly. Observation and correction of the inhaler technique by health care professionals is advised by both national and international guidelines and should be performed at every opportunity to ensure that the optimum inhaler technique is achieved by the user. This study will provide a greater understanding of the most frequent technique errors made by people using 13 different inhaler types.

Objective: This study aims to identify and compare inhaler technique errors and their prevalence in adults, using device-specific checklists in accordance with manufacturers' guidelines, for 13 specific inhaler types across all lung conditions and to correlate these errors with possible determinants of poor technique. It also aims to assess the error frequency at each step in the device-specific questionnaires and compare the error rates among device types.

Methods: In a single visit, participants using an inhaler included in the inclusion criteria will have their inhaler technique observed using an identical placebo device, which will be recorded using device-specific checklists, and technique-optimized, or switched to a suitable inhaler.

Results: The study is already underway, and it is anticipated that the results will be available by 2022.

Conclusions: The SCORES (Study to Investigate the Prevalence of Device-Specific Errors in Inhaler Technique in Adults With Airway Disease) study will ascertain the prevalence of device-specific inhaler technique errors at each step in the device-specific checklists, compare error rates among 13 device types, and correlate these errors with possible determinants of poor technique. Future work will involve the clarification and classification of these errors into critical and noncritical categories.

Trial registration: ClinicalTrials.gov NCT04262271; https://ichgcp.net/clinical-trials-registry/NCT04262271.

International registered report identifier (irrid): DERR1-10.2196/26350.

Keywords: COPD; asthma; inhaler; inhaler technique; inhaler technique error.

Conflict of interest statement

Conflicts of Interest: TB reports personal grants and personal fees from Astra Zeneca, grants, personal fees and nonfinancial support from GlaxoSmithKline, personal fees and nonfinancial support from Teva, nonfinancial support from Napp Pharmaceuticals, and personal fees and nonfinancial support from Novartis, all of which are outside of the submitted work. HR reports honoraria and lecture fees from Astra Zeneca, Teva, Novartis, GlaxoSmithKline, and Chiesi, all of which are outside the submitted work. AJC reports honoraria and lecture fees from Teva, Astra Zeneca, and Sanofi and research grants from Airsonett, Novartis, and GlaxoSmithKline, all of which are outside of the submitted work. The other authors report no conflicts of interest.

©Ruth De Vos, Thomas Brown, Jayne Longstaff, Mitch Lomax, Heather Mackenzie, Alexander Hicks, Hitasha Rupani, Jessica Gates, Lauren Fox, Laura Wiffen, Anoop J Chauhan. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 27.08.2021.

References

    1. Trueman D, Woodcock F, Hancock E. Estimating the economic burden of respiratory illness in the UK. British Lung Foundation. [2019-04-13]. .
    1. Usmani OS, Lavorini F, Marshall J, Dunlop WC, Heron L, Farrington E, Dekhuijzen R. Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes. Respir Res. 2018 Jan 16;19(1):10. doi: 10.1186/s12931-017-0710-y. 10.1186/s12931-017-0710-y
    1. Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur Respir J. 2002 Feb 01;19(2):246–51. doi: 10.1183/09031936.02.00218402.
    1. Lindgren S, Bake B, Larsson S. Clinical consequences of inadequate inhalation technique in asthma therapy. Eur J Respir Dis. 1987 Feb;70(2):93–8.
    1. Lavorini F, Magnan A, Dubus JC, Voshaar T, Corbetta L, Broeders M, Dekhuijzen R, Sanchis J, Viejo JL, Barnes P, Corrigan C, Levy M, Crompton GK. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008 Apr;102(4):593–604. doi: 10.1016/j.rmed.2007.11.003. S0954-6111(07)00447-7
    1. Hashmi A, Soomro JA, Memon A, Soomro TK. Incorrect inhaler technique compromising quality of life of asthmatic patients. J Med. 2012 Mar 06;13(1):16–21. doi: 10.3329/jom.v13i1.7980.
    1. Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, Serra M, Scichilone N, Sestini P, Aliani M, Neri M, Gruppo Educazionale Associazione Italiana Pneumologi Ospedalieri Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011 Jun;105(6):930–8. doi: 10.1016/j.rmed.2011.01.005. S0954-6111(11)00009-6
    1. Lewis A, Torvinen S, Dekhuijzen PN, Chrystyn H, Watson AT, Blackney M, Plich A. The economic burden of asthma and chronic obstructive pulmonary disease and the impact of poor inhalation technique with commonly prescribed dry powder inhalers in three European countries. BMC Health Serv Res. 2016 Jul 12;16(1):251. doi: 10.1186/s12913-016-1482-7. 10.1186/s12913-016-1482-7
    1. Lavorini F, Fontana GA, Usmani OS. New inhaler devices - the good, the bad and the ugly. Respiration. 2014 May 27;88(1):3–15. doi: 10.1159/000363390. 000363390
    1. Sanchis J, Gich I, Pedersen S, Aerosol Drug Management Improvement Team (ADMIT) Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016 Aug;150(2):394–406. doi: 10.1016/j.chest.2016.03.041. S0012-3692(16)47571-9
    1. Global Initiative for Asthma (GINA) [2019-02-13].
    1. Pocket guide to COPD diagnosis, management, and prevention. Global Initiative for Chronic Obstructive Lung Disease. [2019-06-13]. .
    1. Kocks JW, Chrystyn H, van der Palen J, Thomas M, Yates L, Landis SH, Driessen MT, Gokhale M, Sharma R, Molimard M. Systematic review of association between critical errors in inhalation and health outcomes in asthma and COPD. NPJ Prim Care Respir Med. 2018 Nov 16;28(1):43. doi: 10.1038/s41533-018-0110-x. doi: 10.1038/s41533-018-0110-x.10.1038/s41533-018-0110-x
    1. Basheti I, Bosnic-Anticevich SZ, Armour CL, Reddel HK. Checklists for powder inhaler technique: a review and recommendations. Respir Care. 2014 Jul;59(7):1140–54. doi: 10.4187/respcare.02342. respcare.02342
    1. Chrystyn H, van der Palen J, Sharma R, Barnes N, Delafont B, Mahajan A, Thomas M. Device errors in asthma and COPD: systematic literature review and meta-analysis. NPJ Prim Care Respir Med. 2017 Apr 03;27(1):22. doi: 10.1038/s41533-017-0016-z. doi: 10.1038/s41533-017-0016-z.10.1038/s41533-017-0016-z
    1. Juniper EF, O'Byrne PM, Guyatt GH, Ferrie PJ, King DR. Development and validation of a questionnaire to measure asthma control. Eur Respir J. 1999 Oct;14(4):902–7. doi: 10.1034/j.1399-3003.1999.14d29.x.
    1. Jones PW, Harding G, Berry P, Wiklund I, Chen W, Kline LN. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009 Sep;34(3):648–54. doi: 10.1183/09031936.00102509. 34/3/648
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J, ATS/ EF. Standardisation of spirometry. Eur Respir J. 2005 Aug;26(2):319–38. doi: 10.1183/09031936.05.00034805. 26/2/319
    1. Hughes R. Considering the vignette technique and its application to a study of drug injecting and HIV risk and safer behaviour. Sociol Health Illn. 2001 Dec 27;20(3):381–400. doi: 10.1111/1467-9566.00107.

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