Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes

David B Price; Miguel Román-Rodríguez; R Brett McQueen; Sinthia Bosnic-Anticevich; Victoria Carter; Kevin Gruffydd-Jones; John Haughney; Svein Henrichsen; Catherine Hutton; Antonio Infantino; Federico Lavorini; Lisa M Law; Karin Lisspers; Alberto Papi; Dermot Ryan; Björn Ställberg; Thys van der Molen; Henry Chrystyn

doi:10.1016/j.jaip.2017.01.004

Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes

David B Price, Miguel Román-Rodríguez, R Brett McQueen, Sinthia Bosnic-Anticevich, Victoria Carter, Kevin Gruffydd-Jones, John Haughney, Svein Henrichsen, Catherine Hutton, Antonio Infantino, Federico Lavorini, Lisa M Law, Karin Lisspers, Alberto Papi, Dermot Ryan, Björn Ställberg, Thys van der Molen, Henry Chrystyn

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes.

OBJECTIVE: The CRITical Inhaler mistaKes and Asthma controL study investigated the association between specific inhaler errors and asthma outcomes.

METHODS: This analysis used data from the iHARP asthma review service-a multicenter cross-sectional study of adults with asthma. The review took place between 2011 and 2014 and captured data from more than 5000 patients on demographic characteristics, asthma symptoms, and inhaler errors observed by purposefully trained health care professionals. People with asthma receiving a fixed-dose combination treatment with inhaled corticosteroids and long-acting beta agonist were categorized by the controller inhaler device they used-dry-powder inhalers or metered-dose inhalers: inhaler errors were analyzed within device cohorts. Error frequency, asthma symptom control, and exacerbation rate were analyzed to identify critical errors.

RESULTS: This report contains data from 3660 patients. Insufficient inspiratory effort was common (made by 32%-38% of dry-powder inhaler users) and was associated with uncontrolled asthma (adjusted odds ratios [95% CI], 1.30 [1.08-1.57] and 1.56 [1.17-2.07] in those using Turbohaler and Diskus devices, respectively) and increased exacerbation rate. In metered-dose inhaler users, actuation before inhalation (24.9% of patients) was associated with uncontrolled asthma (1.55 [1.11-2.16]). Several more generic and device-specific errors were also identified as critical.

CONCLUSIONS: Specific inhaler errors have been identified as critical errors, evidenced by frequency and association with asthma outcomes. Asthma management should target inhaler training to reduce key critical errors.

Original language	English
Pages (from-to)	1071-1081.e9
Journal	The journal of allergy and clinical immunology. In practice
Volume	5
Issue number	4
Early online date	14 Mar 2017
DOIs	https://doi.org/10.1016/j.jaip.2017.01.004
Publication status	Published - Jul 2017

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Journal Article

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10.1016/j.jaip.2017.01.004

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Price, D. B., Román-Rodríguez, M., McQueen, R. B., Bosnic-Anticevich, S., Carter, V., Gruffydd-Jones, K., Haughney, J., Henrichsen, S., Hutton, C., Infantino, A., Lavorini, F., Law, L. M., Lisspers, K., Papi, A., Ryan, D., Ställberg, B., van der Molen, T., & Chrystyn, H. (2017). Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes. The journal of allergy and clinical immunology. In practice, 5(4), 1071-1081.e9. https://doi.org/10.1016/j.jaip.2017.01.004

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title = "Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes",

abstract = "BACKGROUND: Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes.OBJECTIVE: The CRITical Inhaler mistaKes and Asthma controL study investigated the association between specific inhaler errors and asthma outcomes.METHODS: This analysis used data from the iHARP asthma review service-a multicenter cross-sectional study of adults with asthma. The review took place between 2011 and 2014 and captured data from more than 5000 patients on demographic characteristics, asthma symptoms, and inhaler errors observed by purposefully trained health care professionals. People with asthma receiving a fixed-dose combination treatment with inhaled corticosteroids and long-acting beta agonist were categorized by the controller inhaler device they used-dry-powder inhalers or metered-dose inhalers: inhaler errors were analyzed within device cohorts. Error frequency, asthma symptom control, and exacerbation rate were analyzed to identify critical errors.RESULTS: This report contains data from 3660 patients. Insufficient inspiratory effort was common (made by 32%-38% of dry-powder inhaler users) and was associated with uncontrolled asthma (adjusted odds ratios [95% CI], 1.30 [1.08-1.57] and 1.56 [1.17-2.07] in those using Turbohaler and Diskus devices, respectively) and increased exacerbation rate. In metered-dose inhaler users, actuation before inhalation (24.9% of patients) was associated with uncontrolled asthma (1.55 [1.11-2.16]). Several more generic and device-specific errors were also identified as critical.CONCLUSIONS: Specific inhaler errors have been identified as critical errors, evidenced by frequency and association with asthma outcomes. Asthma management should target inhaler training to reduce key critical errors.",

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author = "Price, {David B} and Miguel Rom{\'a}n-Rodr{\'i}guez and McQueen, {R Brett} and Sinthia Bosnic-Anticevich and Victoria Carter and Kevin Gruffydd-Jones and John Haughney and Svein Henrichsen and Catherine Hutton and Antonio Infantino and Federico Lavorini and Law, {Lisa M} and Karin Lisspers and Alberto Papi and Dermot Ryan and Bj{\"o}rn St{\"a}llberg and {van der Molen}, Thys and Henry Chrystyn",

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doi = "10.1016/j.jaip.2017.01.004",

language = "English",

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pages = "1071--1081.e9",

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Price, DB, Román-Rodríguez, M, McQueen, RB, Bosnic-Anticevich, S, Carter, V, Gruffydd-Jones, K, Haughney, J, Henrichsen, S, Hutton, C, Infantino, A, Lavorini, F, Law, LM, Lisspers, K, Papi, A, Ryan, D, Ställberg, B, van der Molen, T & Chrystyn, H 2017, 'Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes', The journal of allergy and clinical immunology. In practice, vol. 5, no. 4, pp. 1071-1081.e9. https://doi.org/10.1016/j.jaip.2017.01.004

TY - JOUR

T1 - Inhaler Errors in the CRITIKAL Study

T2 - Type, Frequency, and Association with Asthma Outcomes

AU - Price, David B

AU - Román-Rodríguez, Miguel

AU - McQueen, R Brett

AU - Bosnic-Anticevich, Sinthia

AU - Carter, Victoria

AU - Gruffydd-Jones, Kevin

AU - Haughney, John

AU - Henrichsen, Svein

AU - Hutton, Catherine

AU - Infantino, Antonio

AU - Lavorini, Federico

AU - Law, Lisa M

AU - Lisspers, Karin

AU - Papi, Alberto

AU - Ryan, Dermot

AU - Ställberg, Björn

AU - van der Molen, Thys

AU - Chrystyn, Henry

PY - 2017/7

Y1 - 2017/7

N2 - BACKGROUND: Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes.OBJECTIVE: The CRITical Inhaler mistaKes and Asthma controL study investigated the association between specific inhaler errors and asthma outcomes.METHODS: This analysis used data from the iHARP asthma review service-a multicenter cross-sectional study of adults with asthma. The review took place between 2011 and 2014 and captured data from more than 5000 patients on demographic characteristics, asthma symptoms, and inhaler errors observed by purposefully trained health care professionals. People with asthma receiving a fixed-dose combination treatment with inhaled corticosteroids and long-acting beta agonist were categorized by the controller inhaler device they used-dry-powder inhalers or metered-dose inhalers: inhaler errors were analyzed within device cohorts. Error frequency, asthma symptom control, and exacerbation rate were analyzed to identify critical errors.RESULTS: This report contains data from 3660 patients. Insufficient inspiratory effort was common (made by 32%-38% of dry-powder inhaler users) and was associated with uncontrolled asthma (adjusted odds ratios [95% CI], 1.30 [1.08-1.57] and 1.56 [1.17-2.07] in those using Turbohaler and Diskus devices, respectively) and increased exacerbation rate. In metered-dose inhaler users, actuation before inhalation (24.9% of patients) was associated with uncontrolled asthma (1.55 [1.11-2.16]). Several more generic and device-specific errors were also identified as critical.CONCLUSIONS: Specific inhaler errors have been identified as critical errors, evidenced by frequency and association with asthma outcomes. Asthma management should target inhaler training to reduce key critical errors.

AB - BACKGROUND: Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes.OBJECTIVE: The CRITical Inhaler mistaKes and Asthma controL study investigated the association between specific inhaler errors and asthma outcomes.METHODS: This analysis used data from the iHARP asthma review service-a multicenter cross-sectional study of adults with asthma. The review took place between 2011 and 2014 and captured data from more than 5000 patients on demographic characteristics, asthma symptoms, and inhaler errors observed by purposefully trained health care professionals. People with asthma receiving a fixed-dose combination treatment with inhaled corticosteroids and long-acting beta agonist were categorized by the controller inhaler device they used-dry-powder inhalers or metered-dose inhalers: inhaler errors were analyzed within device cohorts. Error frequency, asthma symptom control, and exacerbation rate were analyzed to identify critical errors.RESULTS: This report contains data from 3660 patients. Insufficient inspiratory effort was common (made by 32%-38% of dry-powder inhaler users) and was associated with uncontrolled asthma (adjusted odds ratios [95% CI], 1.30 [1.08-1.57] and 1.56 [1.17-2.07] in those using Turbohaler and Diskus devices, respectively) and increased exacerbation rate. In metered-dose inhaler users, actuation before inhalation (24.9% of patients) was associated with uncontrolled asthma (1.55 [1.11-2.16]). Several more generic and device-specific errors were also identified as critical.CONCLUSIONS: Specific inhaler errors have been identified as critical errors, evidenced by frequency and association with asthma outcomes. Asthma management should target inhaler training to reduce key critical errors.

KW - Journal Article

U2 - 10.1016/j.jaip.2017.01.004

DO - 10.1016/j.jaip.2017.01.004

M3 - Article

C2 - 28286157

SN - 2213-2201

VL - 5

SP - 1071-1081.e9

JO - The journal of allergy and clinical immunology. In practice

JF - The journal of allergy and clinical immunology. In practice

IS - 4

ER -

Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes

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