Errors in the use of inhalers by healthcare professionals: a systematic review

Publication date: Available online 31 January 2018
Source:The Journal of Allergy and Clinical Immunology: In Practice
Author(s): Vicente Plaza, Jordi Giner, Gustavo J. Rodrigo, Myrna B. Dolovich, Joaquin Sanchis
BackgroundInefficient inhaler technique (IT) compromises the optimal delivery of medication. However, the IT knowledge of health care professionals (HCP) has received scant attention.ObjectiveTo perform a systematic review of published reports assessing the IT proficiency of HCPs in using pressurized metered dose (pMDI) and dry powder (DPI) inhalers.MethodsStudies published between 1975 and 2014 that directly assessed the IT skills of HCPs were selected according to pre-defined selection criteria.ResultsData 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 post-inhalation breath-hold (63%; 95% CI, 52-72). The most common errors using DPT 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).ConclusionHealth care professionals demonstrated an 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.