title: Handling of Diskus dry powder inhaler in Chinese chronic obstructive pulmonary disease patients.
abstract: BACKGROUND
  The incorrect handling of Diskus inhalers in Chinese patients with chronic obstructive pulmonary disease (COPD) is not well documented.
  
  
  OBJECTIVE
  The present study was conducted to evaluate in detail the handling errors related to the Diskus device, and to elucidate the importance of educating COPD patients on the proper use of the device.
  
  
  METHODS
  A total of 384 COPD patients from a pulmonary clinic in China over a period of 5 years were included in the study. The compliance of COPD patients to the 13 discrete steps of Diskus usage were scored and analyzed by three measures: (1) On day 0, patients were given only a package insert on Diskus, and the handling error rate was assessed. Then the patients were given instruction on the 13-step Diskus procedure until they could demonstrate the proper technique. (2) On days 1, 2, and 3, the observation group was continuously educated on a 13-step procedure, and the percentage of patients who scored 100% for each step was recorded. The control group had no such training. (3) On days 10, 20, and 30, the percentage of all subjects correctly performing the Diskus 13-step inhalation procedure was assessed.
  
  
  RESULTS
  Incorrect handling techniques on Diskus usage were widely distributed among Chinese COPD patients. Step 8 ("Inhale forcefully from the beginning, slowly, deeply, and uniformly during the inspiratory phase until the lungs are full") was the most commonly mishandled step (93.8%). The total score and individual step scores of the patients from the observation group were significantly improved during 3-day continuous education. There was also a significantly higher percentage of correctly performed steps in the observation group than in the control group upon assessment on day 10 (96.24% vs. 85.63%, respectively; p<0.01), day 20 (97.31% vs. 86.09%, respectively; p<0.01), and day 30 (98.19% vs. 87.39%, respectively; p<0.01).
  
  
  CONCLUSIONS
  Handling errors of the Diskus 13-step inhalation procedure were commonly observed in Chinese COPD patients. Continuous educational interventions and regular supervision by health-care providers are therefore crucial for the optimum use of the Diskus inhaler.
authors.affiliation: 1 Department of Respiratory Disease, the 88th Hospital of the Chinese People's Liberation Army , Tai'an 271000, China .
authors.forename: Huaidong
authors.initials: H
authors.lastname: Li
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Chen
authors.forename: Zhaorui
authors.initials: Z
authors.lastname: Zhang
authors.forename: Xiaoxuan
authors.initials: X
authors.lastname: Dong
authors.forename: Guogang
authors.initials: G
authors.lastname: Zhang
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000523:psychology*; D002681:China; D058995:Dry Powder Inhalers; D004867:Equipment Design; D005260:Female; D005541:Forced Expiratory Volume; D015438:Health Behavior / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology; D013647:Task Performance and Analysis; D014797:Vital Capacity
keywords: COPD; Diskus; chronic obstructive pulmonary disease; drug; handling error; inhaler technique; patient education