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Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review

Published:January 17, 2018DOI:https://doi.org/10.1016/j.jaip.2017.12.032

      Background

      Inefficient inhaler technique (IT) compromises the optimal delivery of medication. However, the IT knowledge of health care professionals (HCPs) has received scant attention.

      Objective

      The objective of this study was to perform a systematic review of published reports assessing the IT proficiency of HCPs in using pressurized metered dose (pMDI) and dry powder (DPI) inhalers.

      Methods

      Studies published between 1975 and 2014 that directly assessed the IT skills of HCPs were selected according to predefined selection criteria.

      Results

      Data were extracted from 55 studies involving 6,304 HCPs who performed 9,996 tests to demonstrate their IT proficiency. Overall, the IT was considered correct in 15.5% of cases (95% confidence interval [CI], 12-19.3), decreasing over time from 20.5% (95% CI, 14.9-26.8) from the early period (defined as 1975-1995) to 10.8% (95% CI, 7.3-14.8) during the late period (1996-2014). The most common errors in the use of pMDIs were as follows: not breathing out completely before inhalation (75%; 95% CI, 56-90), lack of coordination (64%; 95% CI, 29-92), and postinhalation breath-hold (63%; 95% CI, 52-72). The most common errors using DPI were deficient preparation (89%; 95% CI, 82-95), not breathing out completely before inhalation (79%; 95% CI, 68-87), and no breath-hold (76%; 95% CI, 67-84).

      Conclusions

      HCPs demonstrated inadequate knowledge of the proper use of inhalers. The poor understanding of the correct use of these devices may prevent these professionals from being able to adequately assess and teach proper inhalation techniques to their patients.

      Key words

      Abbreviations used:

      CI (Confidence interval), COPD (Chronic obstructive pulmonary disease), DPI (Dry powder inhaler), HCP (Health care professional), I2 (Study heterogeneity), IC (Inhalation chamber), IT (Inhaler technique), MeSH (Medical subject heading), pMDI (Pressurized metered-dose inhaler), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
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