The Journal of Allergy and Clinical Immunology: In Practice
Original ArticleErrors in the Use of Inhalers by Health Care Professionals: A Systematic Review
Section snippets
Methods
The selection criteria and methods used in this review were similar to those of a recent systematic review conducted by members of our group.5 See https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=9347 for full details of the protocol.
Results
The electronic database searches yielded 404 articles on IT by HCPs. After removing duplicates and unrelated articles, articles not contributing new data or that did not evaluate overall technique were also excluded (Figure 1). After the full screening process was completed, a total of 55 articles met all inclusion criteria.18, 19, 20, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70
Discussion
This systematic review shows that a majority of HCPs involved in caring for patients with respiratory diseases exhibited poor knowledge of the inhalation technique for the main inhalers they prescribe, administer, or supervise. This is a clinically relevant deficiency. Moreover, the rate at which IT was correctly performed decreased considerably in the later years of the study period. Two of the most common IT errors observed in pMDI and DPI, respectively, were lack of coordination (step 3) and
Acknowledgements
We would like to thank Marta Pulido, MD, PhD, and Bradley Londres for their editorial assistance with this manuscript. V. Plaza was responsible for the conception and design of the study, coordination and supervision of all tasks, and writing of the manuscript; J. Giner was responsible for the search of databases, selection of studies and data extraction, development of the study database, and critical review of the manuscript for intellectual content; G. J. Rodrigo was responsible for the
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2022, Respiratory MedicineCitation Excerpt :Patients and healthcare professionals (HCP) often over-estimate medication adherence, leading to unnecessary testing and treatments [13–16]. Similarly, improper inhaler technique is inconsistently addressed during office visits [17,18] and if taught, technique wanes [19] and patients change devices. Current circumstances favoring smart inhalers include widespread use of technology by patients, payer support [20,21], policy organizations recognizing their importance [22,23], widespread use of quality metrics, and expansion of telehealth.
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2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :National Heart, Lung, and Blood Institute (NHLBI) guidelines and the Global Initiative for Asthma (GINA) recommend that inhaler technique should be assessed at each patient visit, but do not state how this should be carried out.3,17 Furthermore, a study conducted by Plaza and colleagues18 found that only 15.5% of health care professionals (HCPs) had adequate knowledge of correct inhaler technique. ProAir Digihaler (Teva Pharmaceuticals, Israel, “albuterol Digihaler” or “digital reliever inhaler”) is a U.S. Food and Drug Administration (FDA)–approved albuterol electronic multidose breath-actuated dry powder inhaler capable of accurately and objectively recording inhaler usage (quantity and timing of use), together with inhalation quality parameters, including peak inspiratory flow (PIF), inhalation volume, inhalation duration, and time to PIF.19
Digital Inhalers and Remote Patient Monitoring for Asthma
2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :In a study of patients with asthma under specialist care, inhaler technique was not checked in 80%.19 In a recent meta-analysis, only 15.5% of HCPs demonstrated proficiency in the use of metered dose inhalers and dry powder inhalers.20 Although most specialty and primary care HCPs agree that inhaler technique teaching is important, they may not be playing an active role to execute this at each visit due to lack of knowledge and training themselves and time constraints.19,20
No funding was received for this work.
Conflicts of interest: The authors declare that they have no relevant conflicts of interest.