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| |  Inhalers Misused by One Third of Pulmonary Patients: Presented at CHEST By Em Brown CHICAGO, IL -- October 26, 2007 -- A significant percentage of patients use their inhalers incorrectly, with the percentage that makes errors increasing with patients' age and severity of disease, researchers reported here at CHEST 2007, the 73rd international scientific assembly of the American College of Chest Physicians (ACCP). To compound the problem further, one third of patients never receive direct instruction on how to use the devices, but are simply sent home with their prescriptions and told to read the product inserts, said study presenter Siegfried Wieshammer, MD, Medical Director, Department of Internal Medicine, Klinikum Offenburg, Offenburg, Germany. Dr. Wieshammer presented findings on the error rate with inhaler use in 224 patients mean age was 55 years who were diagnosed with asthma or chronic obstructive pulmonary disease (COPD) who were newly prescribed dry-powder inhalers. The overall error rate in this study sample was 32%, Dr. Wieshammer reported, but there was a wide variation in that rate, depending on the patient's age and disease severity. The error rate was 20.0% for patients younger than age 60 years, 41.6% for those older than 60 years, and greater than 80% for those older than 80 years. The error rate also varied with severity of disease. It was 25.0% for patients with normal lung function and 63.6% for patients with severe airway obstruction, Dr. Wieshammer said. When trained by healthcare providers on the proper use of the inhaler, the error rate was 23%, whereas an error rate of 53% was found in patients who had not received training in inhaler use. "Healthcare providers must adopt modern teaching techniques to meet the educational requirements of their patients," Dr. Wieshammer commented in an interview. "High-quality training devices are available." "In older patients, the risk of ineffective inhalation remains high despite prior instruction," Dr. Wieshammer said. "I do not advise against the use of dry powder inhalers in the elderly, but I do recommend checking older patients` inhalational technique regularly to ensure the efficacy of treatment." "If crucial handling errors cannot be eliminated by follow-up training, a metered-dose inhaler in combination with a large-volume spacer might be a valuable treatment alternative, in my experience," he advised. "This device allows the patient to inhale the aerosol at a low inspiratory flow without worrying about the need to coordinate actuation and inhalation. Even older patients with advanced COPD can properly use this device after training, if necessary with the help of a partner or caregiver." Dr. Wieshammer has received some funding from AstraZeneca and from GlaxoSmithKline.
[Presentation Title: Dry Powder Inhalers in Asthma and COPD: Which Factors Determine the Frequency of Handling Errors? A Study of Aerolizer, Discus, Handihaler and Turbuhaler.]
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