Clinical recommendations for dry powder inhaler use in the management of COPD in primary care

Over 1400 patients using dry powder inhalers (DPIs) to deliver COPD maintenance therapies were recruited across Europe and Australia. Their peak inspiratory flow (PIF) was measured, inhaler technique was observed, and adherence to treatment assessed. From relating the findings with patient health st...

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Bibliographic Details
Authors: Leving, Marika T, Bosnic-Anticevich, Sinthia, van Cooten, Joyce, Correia de Sousa, Jaime, Cvetkovski, Biljana, Dekhuijzen, Richard, Dijk, Lars, Garcia Pardo, Marina, Gardev, Asparuh, Gawlik, Radosław, van der Ham, Iris, Janse, Ymke, Lavorini, Federico, Maricoto, Tiago, Meijer, Jiska, Metz, Boyd, Price, David, Roman-Rodriguez, Miguel, Schuttel, Kirsten, Stoker, Nilouq, Tsiligianni, Ioanna, Usmani, Omar, Emerson-Stadler, Rachel, Kocks, Janwillem WH
Format: article
Publication Date:2022
Country:España
Institution:Instituto de Salud Carlos III (ISCIII)
Repository:Repisalud
Language:English
OAI Identifier:oai:repisalud.isciii.es:20.500.12105/23402
Online Access:https://hdl.handle.net/20.500.12105/23402
Access Level:Open access
Keyword:Enfermedad Pulmonar Obstructiva Crónica
Humanos
Inhaladores de Dosis Medida
Atención Primaria de Salud
Administración por Inhalación
Inhaladores de Polvo Seco
Dry Powder Inhalers
Administration, Inhalation
Pulmonary Disease, Chronic Obstructive
Humans
Primary Health Care
Metered Dose Inhalers
Description
Summary:Over 1400 patients using dry powder inhalers (DPIs) to deliver COPD maintenance therapies were recruited across Europe and Australia. Their peak inspiratory flow (PIF) was measured, inhaler technique was observed, and adherence to treatment assessed. From relating the findings with patient health status, and thereby identifying critical errors, key clinical recommendations for primary care clinicians were determined, namely - measure PIF before prescribing a DPI to ensure inhalation manoeuvre ability is well-matched with the device. Some patients could benefit from inhalation training whereas others should have their DPI changed for one better suited to their inspiratory ability or alternatively be prescribed an active device (such as a soft mist inhaler or pressurized metered dose inhaler). Observing the inhalation technique was valuable however this misses suboptimal PIF (approaching one fourth of patients with a satisfactory observed manoeuvre had a suboptimal PIF for their DPI). Assess adherence as deliberate non-adherence can point to a mismatch between a patient and their inhaler (deliberate non-adherence was significantly associated with PIFs below the minimum for the DPI). In-person observation of inhalation technique was found to be inferior to video rating based on device-specific checklists. Where video assessments are not possible, observation training for healthcare professionals would therefore be valuable particularly to improve the ability to identify the critical errors associated with health status namely 'teeth and lips sealed around mouthpiece', 'breathe in' and 'breathing out calmly after inhalation'. However, it is recommended that observation alone should not replace PIF measurement in the DPI selection process.Trial registration: https://clinicaltrials.gov/ct2/show/NCT04532853 .

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