Editorial--How Important Are Inhaler Technique Errors?

Abstract

Treatment of respiratory diseases, including chronic obstructive pulmonary disease (COPD) and asthma, depends primarily on inhaled medications. Because of the complexity of inhaled medication delivery, patients’ mastery of inhalers presents a major challenge to these treatments. Further, the skill requirements vary across medication devices, including metered-dose inhalers (MDIs), breath-activated MDIs, soft-mist inhalers, dry-powder inhalers (DPIs), and nebulizers, adding further potential confusion for both prescribers and patients. A large body of literature has documented the frequency of patient inhaler errors and the correlation of these with worsening outcomes1 accounting for nearly $900 million in direct and indirect costs.2 The manuscript by Cho-Reyes et al in this issue of the Journal of the COPD Foundation adds to this literature, combining a systematic review and meta-analysis. Ten previously published reports including 1360 patients revealed that 86.7% of patients made at least 1 inhalation technique error, and that 76.8% of patients made multiple errors. These results confirm a previous report of 54 studies showing that 86.8% of patients using an MDI and 60.9% of patients using a DPI made at least 1 error.3