title: Irregular and Ineffective: A Quantitative Observational Study of the Time and Technique of Inhaler Use.
abstract: Cross-sectional observational studies suggest that between 50% and 60% of patients misuse a dry powder inhaler, whereas studies with electronic monitors indicate that patients sometimes overuse/underuse their inhalers. It is not known what impact errors and erratic use have on inhaler adherence.
  
  
  
  The purpose of this study was to longitudinally quantify when and how patients adhered to a twice-daily preventer treatment by using a novel acoustic recording device attached to an inhaler (INhaler Compliance Assessment).
  
  
  
  Patients with a history of asthma or chronic obstructive pulmonary disease (n = 123) from primary care and community pharmacies were given an INhaler Compliance Assessment-adapted inhaler for 1 month. Analysis of the audio files provided quantitative information on time and technique of inhaler use.
  
  
  
  Data were available for 103 patients. Twenty-one patients (20%) used their inhaler in the correct manner at the correct interval. There were 5045 audio files with attempted inhalations, of which 1204 had technique errors (24%). Errors included inadequate flow (27%), drug priming without inhalation (19%), exhalation into the inhaler (18%), and multiple inhalations (25%). On average, participants made errors 20% of the time. Of 60 doses expected to be taken in a month per person, on average 49 doses (82%) were attempted and when errors were accounted for, the average number of actual doses taken was 34 doses (57%; P < .01) comparing attempted to actual doses.
  
  
  
  These data highlight that ineffective and irregular inhaler use is common and when combined in a single calculation indicate that only 20% of participants used their inhaler correctly and on time.
authors: Department of Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland. Electronic address: imransulaiman@rcsi.ie.
authors: Imran
authors: I
authors: Sulaiman
authors: Department of Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
authors: Jansen
authors: J
authors: Seheult
authors: Respiratory Department, Clinical Research Centre, RCSI, Dublin, Ireland.
authors: Elaine
authors: E
authors: MacHale
authors: Trinity Centre for Bioengineering, Trinity College, University of Dublin, Dublin, Ireland.
authors: Shona
authors: S
authors: D'Arcy
authors: RCSI Population Health Sciences, RCSI, Dublin, Ireland.
authors: Fiona
authors: F
authors: Boland
authors: Primary Care Practice, Finglas Family Practice, Dublin, Ireland.
authors: Katrina
authors: K
authors: McCrory
authors: Primary Care Practice, Beaumont Park Clinic, Beaumont Woods, Dublin, Ireland.
authors: John
authors: J
authors: Casey
authors: Primary Care Practice, Coombe Medical Centre, Dublin, Ireland.
authors: Gerard
authors: G
authors: Bury
authors: Department of Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
authors: Mazen
authors: M
authors: Al-Alawi
authors: School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
authors: Susan
authors: S
authors: O'Dwyer
authors: School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
authors: Sheila A
authors: SA
authors: Ryder
authors: Trinity Centre for Bioengineering, Trinity College, University of Dublin, Dublin, Ireland.
authors: Richard B
authors: RB
authors: Reilly
authors: Department of Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; Respiratory Department, Clinical Research Centre, RCSI, Dublin, Ireland.
authors: Richard W
authors: RW
authors: Costello
mesh_terms: D000162:Acoustics; D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy; D058995:Dry Powder Inhalers / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D055815:Young Adult
keywords: Asthma; COPD; Community pharmacy population; General practice; Inhaler devices; Pharmacology