Time required to rectify inhaler errors among experienced subjects with faulty technique

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 multicenter, 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.