title: Inhalation errors due to device switch in patients with chronic obstructive pulmonary disease and asthma: critical health and economic issues.
abstract: BACKGROUND
  Different inhalation devices are characterized by different techniques of use. The untrained switching of device in chronic obstructive pulmonary disease (COPD) and asthma patients may be associated with inadequate inhalation technique and, consequently, could lead to a reduction in adherence to treatment and limit control of the disease. The aim of this analysis was to estimate the potential economic impact related to errors in inhalation in patients switching device without adequate training.
  
  
  METHODS
  An Italian real-practice study conducted in patients affected by COPD and asthma has shown an increase in health care resource consumption associated with misuse of inhalers. Particularly, significantly higher rates of hospitalizations, emergency room visits (ER), and pharmacological treatments (steroids and antimicrobials) were observed. In this analysis, those differences in resource consumption were monetized considering the Italian National Health Service (INHS) perspective.
  
  
  RESULTS
  Comparing a hypothetical cohort of 100 COPD patients with at least a critical error in inhalation vs 100 COPD patients without errors in inhalation, a yearly excess of 11.5 hospitalizations, 13 ER visits, 19.5 antimicrobial courses, and 47 corticosteroid courses for the first population were revealed. In the same way, considering 100 asthma patients with at least a critical error in inhalation vs 100 asthma patients without errors in inhalation, the first population is associated with a yearly excess of 19 hospitalizations, 26.5 ER visits, 4.5 antimicrobial courses, and 21.5 corticosteroid courses. These differences in resource consumption could be associated with an increase in health care expenditure for INHS, due to inhalation errors, of €23,444/yr in COPD and €44,104/yr in asthma for the considered cohorts of 100 patients.
  
  
  CONCLUSIONS
  This evaluation highlights that misuse of inhaler devices, due to inadequate training or nonconsented switch of inhaled medications, is associated with a decrease in disease control and an increase in health care resource consumption and costs.
authors.affiliation: ProCure Solutions, Nembro, Bergamo, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Roggeri
authors.affiliation: Respiratory Unit, Mater Salutis Hospital, Legnago, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Micheletto
authors.affiliation: ProCure Solutions, Nembro, Bergamo, Italy.
authors.forename: Daniela Paola
authors.initials: DP
authors.lastname: Roggeri
mesh_terms: D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D006801:Humans; D007558:Italy; D008508:Medication Errors / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
keywords: COPD; asthma; costs; devices; errors; inhalers; switch; training