title: Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD.
abstract: Inhaled therapies are the cornerstone of pharmacologic management for COPD. Each device requires a unique series of steps to be most effective, making appropriate instruction in inhaler technique a key part of the management of COPD.
  
  
  
  Examine characteristics of patients and devices associated with poor technique among patients with COPD.
  
  
  
  Cross-sectional study of subjects with COPD using at least one of: metered dose inhaler, Advair Diskus, Spiriva Handihaler, identified from the COPD Outcomes-based Network for Clinical Effectiveness and Research Translation (CONCERT) registry. Technique was assessed face-to-face using manufacturer-provided dummy inhalers, with standardized checklists for each device. We used logistic regression to model associations with poor inhaler technique, defined as an error in ≥20% of the steps, as a function of patient characteristics, with educational attainment the primary predictor.
  
  
  
  688 individuals meet eligibility criteria, 65.5% had poor technique for at least one device. In adjusted analyses, Black race was associated with poor technique (OR 3.25, 95%CI 1.86-5.67) while greater than high school education was associated with decreased odds of poor technique (OR 0.35, 95%CI 0.17-0.70 for trade school/some college, OR 0.25, 95%CI 0.11-0.61 for college or more, p ≤ 0.001 for test of linear trend). The percentage of errors varied between devices, with subjects making proportionally the most errors for MDIs.
  
  
  
  Poor inhaler technique is common among individuals with COPD, varies between devices, and is associated with race and educational attainment. Tailored educational interventions to teach inhaler technique should be part of the process of initiating and monitoring inhaled therapies.
authors.affiliation: Division of Pulmonary and Critical Care, University of Washington, USA; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, USA; VA Puget Sound Health Care System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA. Electronic address: acmelzer@uw.edu.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Melzer
authors.affiliation: Division of Pulmonary and Critical Care, University of Washington, USA.
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Ghassemieh
authors.affiliation: Kaiser Permanente Northwest, Center for Health Research, Portland, OR, USA.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Gillespie
authors.affiliation: Baystate Medical Center, Department of Medicine, USA.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
authors.affiliation: Kaiser Permanente Northwest, Center for Health Research, Portland, OR, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: McBurnie
authors.affiliation: Kaiser Permanente Northwest, Center for Health Research, Portland, OR, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mularski
authors.affiliation: University of Chicago, Department of Medicine, USA.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Naureckas
authors.affiliation: Kaiser Permanente Northwest, Center for Health Research, Portland, OR, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Vollmer
authors.affiliation: Division of Pulmonary and Critical Care, University of Washington, USA; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance / Q000208:ethnology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012646:Self Administration / Q000379:methods / Q000592:standards; D012720:Severity of Illness Index; D014481:United States
keywords: Adherence; Chronic obstructive pulmonary disease (COPD); Inhaled therapy; Technique