title: Time Required to Rectify Inhaler Errors Among Experienced Subjects With Faulty Technique.
abstract: BACKGROUND
  Regardless of the device used, many patients have difficulty maintaining proper inhaler technique over time. Repeated education from caregivers is required to ensure persistence of correct inhaler technique, but no information is available to evaluate the time required to rectify inhaler errors in experienced users with a baseline faulty technique and whether this time of re-education to restore inhaler mastery can differ between devices.
  
  
  METHODS
  This was a multi-center, single-visit, open-label, cross-sectional study in a large group of 981 adult subjects (mean ± SD age 64 ± 15 y) experienced with inhaler use, mainly suffering from COPD and asthma, who showed faulty inhaler technique at a follow-up visit in chest clinics. These subjects received face-to-face practical education from trained caregivers until proper inhaler use could be demonstrated, and the time of instruction was recorded.
  
  
  RESULTS
  The mean times (95% CIs) in minutes of instruction required for rectifying misuse and demonstrating inhaler mastery were 5.0 (3.6-6.4) min for the Diskus (n= 199), 5.3 (3.7-6.8) min for the HandiHaler (n= 219), 8.1 (5.6-10.5) min for the metered-dose inhaler (MDI) (n= 532), and 6.0 (5.0-7.0) min for the Turbuhaler (n= 169). The time to demonstrate good inhaler use for MDIs was higher (P< .05) than for all dry powder inhalers (DPIs). Between the DPIs, only the HandiHaler required more time for achieving mastery than the Diskus (P= .005). The variables associated with increasing time for correcting inhaler errors were an older age (0.05 min/y, 95% CI 0.03-0.07), a lower level of education (0.4 min/schooling level, 95% CI 0.7-0.1), and no reported previous instruction in inhaler use (1.96 min, 95% CI 1.35-2.58).
  
  
  CONCLUSIONS
  In experienced subjects with baseline faulty inhaler use, the mean time of education required to achieve and demonstrate mastery with DPIs was lower than with MDIs.
authors.affiliation: Fisiopatologia e Riabilitazione Respiratoria, Policlinico Le Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy. a.melani@ao-siena.toscana.it.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Melani
authors.affiliation: Pneumologia, Ospedale La Colletta, Arenzano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bonavia
authors.affiliation: Fisiopatologia Respiratoria, IRCCS Regina Elena, Rome, Italy.
authors.forename: Eliuccia
authors.initials: E
authors.lastname: Mastropasqua
authors.affiliation: SOC Medicina, Ospedale S. Luca, Trecenta, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zanforlin
authors.affiliation: Malattie Apparato Respiratorio, Ospedale di Copparo, Ferrara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lodi
authors.affiliation: Centro anti-fumo, Ospedale Cardarelli, Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Martucci
authors.affiliation: Dipartimento Medicina, Pneumologia, Fisiologia e Nutrizione Umana, Università di Palermo, Palermo, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Scichilone
authors.affiliation: Divisione di Pneumologia, ICCRS Fondazione Maugeri, Cassano delle Murge, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Aliani
authors.affiliation: Istituto Fondazione Renato Piatti, Varese, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Neri
authors.affiliation: Clinica Malattie Apparato Respiratorio, Università di Siena, Siena, Italy.
authors.forename: Piersante
authors.initials: P
authors.lastname: Sestini
mesh_terms: D000368:Aged; D001249:Asthma / Q000523:psychology / Q000628:therapy*; D003430:Cross-Sectional Studies; D058995:Dry Powder Inhalers; D005260:Female; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy*; D013997:Time Factors
keywords: COPD; asthma; inhaler device