Inhaler devices: A prospective cross-sectional study on inhaler mishandling

Background The main route for drug delivery in many respiratory illnesses is the inhalation route. Increasing number of inhaler devices have been approved by drug regulatory authorities. Failure to use the drug delivery devices properly has been shown to affect the control of diseases negatively. Research studies concerning the inhalation devices handling difficulties have been published previously; however, local data are lacking. Aim We aimed to study the technical errors among patients while handling the different available inhaler devices. We also aimed to compare between different devices regarding usage prevalence, duration of use and patient adherence. Patients and methods The study was a prospective, cross-sectional, observational study. It was conducted on patients aged greater than 12 years, who used an inhaler regularly for more than 4 weeks. Each patient demonstrated the inhalation technique using their inhaler, showing their usual inhalation technique. Technical mistakes that are likely to make therapy ineffective using devices metered-dose inhaler (MDI) and dry powder inhaler (Diskus, Turbohaler, Breezhaler, Handihaler, Ellipta) were recorded. A statistics analysis was then performed. Results A total of 221 patients were enrolled, comprising 116 (52.5%) males and 105 (47.5%) females, with a mean age of 47.6 ± 18.5 years. Bronchial asthma was the most frequent disease in 191 (84.6%) patients. The enrolled 221 patients used a total of 280 inhalation maneuvers with six different inhaler devices: 97 (34.6%) used MDI, 82 (29.3%) used Turbohaler, 58 (20.7%) used Diskus, 27 (9.7%) used Handihaler, and nine (3.2%) used Ellipta. A total of 167 (75.6%) patients used a single device, whereas the MDIs had the longest duration of use among the studied cases (mean: 56.15 months). The compliance was much higher among patients using Turbohaler and Handihaler (70 and 85%, respectively). Analysis of technical errors experienced by the studied patients shows that using Diskus or Turbohaler is accompanied by more frequent error compared with other devices (1.82 per patient and 1.73, respectively), whereas Handihaler had the least recorded error per patient (0.48). Conclusion Inhaler mishandling and compliance remain common problem in our locality. A good inhalation technique is mainly affected by the type of the device. Instructions given by health caregivers are the only modifiable factors useful for decreasing inhaler mishandling.