Published online: January 17, 2018
Studies in the last 20 years showed that chronic respiratory patients and health care professionals (HCP) have insufficient knowledge about the correct use of inhaler devices.
The objective of the present study by Plaza et al, published in The Journal of Allergy and Clinical Immunology: In Practice, was to perform a rigorous systematic review of published reports (between 1975 and 2014) assessing the inhaler technique (IT) proficiency of HCPs in using pressurized metered dose (pMDI) and dry powder (DPI) inhalers. Data were extracted from 55 studies involving 6,304 HCPs who performed 9,996 tests.
Overall, the IT was considered correct in 15.5% of cases, decreasing over time from 20.5% from the early period (defined as 1975-1995) to 10.8% during the late period (1996-2014). The most common errors in the use of pMDIs were as follows: not breathing out completely before inhalation (75%), lack of coordination (64%), and post-inhalation breath-hold (63%). The most common errors using DPI were: deficient preparation (89%), not breathing out completely before inhalation (79%), and no breath-hold (76%).
This is the first systematic review to show that a substantial majority of HCPs do not use the main inhaler types properly. And surprisingly, their IT skills have worsened in recent years. The high incorrect inhaler use found among HCPs may prevent effective patient training.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.