title: Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting.
abstract: OBJECTIVE
  Correct inhaler technique is central to effective delivery of asthma therapy. The study aim was to identify factors associated with serious inhaler technique errors and their prevalence among primary care patients with asthma using the Diskus dry powder inhaler (DPI).
  
  
  METHODS
  This was a historical, multinational, cross-sectional study (2011-2013) using the iHARP database, an international initiative that includes patient- and healthcare provider-reported questionnaires from eight countries. Patients with asthma were observed for serious inhaler errors by trained healthcare providers as predefined by the iHARP steering committee. Multivariable logistic regression, stepwise reduced, was used to identify clinical characteristics and asthma-related outcomes associated with ≥1 serious errors.
  
  
  RESULTS
  Of 3681 patients with asthma, 623 (17%) were using a Diskus (mean [SD] age, 51 [14]; 61% women). A total of 341 (55%) patients made ≥1 serious errors. The most common errors were the failure to exhale before inhalation, insufficient breath-hold at the end of inhalation, and inhalation that was not forceful from the start. Factors significantly associated with ≥1 serious errors included asthma-related hospitalization the previous year (odds ratio [OR] 2.07; 95% confidence interval [CI], 1.26-3.40); obesity (OR 1.75; 1.17-2.63); poor asthma control the previous 4 weeks (OR 1.57; 1.04-2.36); female sex (OR 1.51; 1.08-2.10); and no inhaler technique review during the previous year (OR 1.45; 1.04-2.02).
  
  
  CONCLUSIONS
  Patients with evidence of poor asthma control should be targeted for a review of their inhaler technique even when using a device thought to have a low error rate.
authors.affiliation: a Research in Real-Life, Ltd , Cambridge , United Kingdom .
authors.forename: Janine A M
authors.initials: JA
authors.lastname: Westerik
authors.affiliation: b Optimum Patient Care Ltd , Cambridge , United Kingdom .
authors.forename: Victoria
authors.initials: V
authors.lastname: Carter
authors.affiliation: a Research in Real-Life, Ltd , Cambridge , United Kingdom .|c Inhalation Consultancy, Ltd , Yeadon , Leeds , United Kingdom .
authors.forename: Henry
authors.initials: H
authors.lastname: Chrystyn
authors.affiliation: a Research in Real-Life, Ltd , Cambridge , United Kingdom .
authors.forename: Anne
authors.initials: A
authors.lastname: Burden
authors.affiliation: a Research in Real-Life, Ltd , Cambridge , United Kingdom .
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Thompson
authors.affiliation: d Woodbrook Medical Centre, Loughborough, United Kingdom, Centre for Population Health Sciences, University of Edinburgh , United Kingdom .
authors.forename: Dermot
authors.initials: D
authors.lastname: Ryan
authors.affiliation: e Box Surgery , Box , United Kingdom .
authors.forename: Kevin
authors.initials: K
authors.lastname: Gruffydd-Jones
authors.affiliation: f Academic Primary Care, University of Aberdeen , Aberdeen , United Kingdom .
authors.forename: John
authors.initials: J
authors.lastname: Haughney
authors.affiliation: g University Paris Descartes (EA2511), Cochin Hospital Group (AP-HP) , Paris , France .
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.affiliation: h Department of Experimental and Clinical Medicine , Careggi University Hospital , Florence , Italy .
authors.forename: Federico
authors.initials: F
authors.lastname: Lavorini
authors.affiliation: i Department of Medical Sciences , University of Ferrara , Ferrara , Italy .
authors.forename: Alberto
authors.initials: A
authors.lastname: Papi
authors.affiliation: j Special Interest Respiratory Area, Società Italiana Interdisciplinare per le Cure Primarie , Bari , Italy .
authors.forename: Antonio
authors.initials: A
authors.lastname: Infantino
authors.affiliation: k Primary Care Respiratory Research Unit, Instituto de Investigación Sanitaria de Palma IdisPa , Palma de Mallorca , Spain .
authors.forename: Miguel
authors.initials: M
authors.lastname: Roman-Rodriguez
authors.affiliation: l Sydney Medical School and the Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia .
authors.forename: Sinthia
authors.initials: S
authors.lastname: Bosnic-Anticevich
authors.affiliation: m Department of Public Health and Caring Sciences , Preventive Medicine and Family Medicine, Uppsala University , Uppsala , Sweden .
authors.forename: Karin
authors.initials: K
authors.lastname: Lisspers
authors.affiliation: m Department of Public Health and Caring Sciences , Preventive Medicine and Family Medicine, Uppsala University , Uppsala , Sweden .
authors.forename: Björn
authors.initials: B
authors.lastname: Ställberg
authors.affiliation: n Department of General Medicine , University of Oslo and Langbølgen Legesenter , and.
authors.forename: Svein Høegh
authors.initials: SH
authors.lastname: Henrichsen
authors.affiliation: o Department of Primary Care , University of Groningen, University Medical Centre Groningen , Groningen , The Netherlands.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.affiliation: a Research in Real-Life, Ltd , Cambridge , United Kingdom .
authors.forename: Catherine
authors.initials: C
authors.lastname: Hutton
authors.affiliation: a Research in Real-Life, Ltd , Cambridge , United Kingdom .|f Academic Primary Care, University of Aberdeen , Aberdeen , United Kingdom .
authors.forename: David B
authors.initials: DB
authors.lastname: Price
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D058995:Dry Powder Inhalers / Q000706:statistics & numerical data*; D004522:Educational Status; D004867:Equipment Design; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011320:Primary Health Care; D012307:Risk Factors; D012737:Sex Factors
keywords: Asthma therapy; Diskus inhaler; cross-sectional; inhalation devices; multinational
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