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Assessment of Poor Inhaler Technique in Older Patients with Asthma or COPD: A Predictive Tool for Clinical Risk and Inhaler Performance

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Abstract

Background/Objectives

Older patients with asthma or chronic obstructive pulmonary disease (COPD) are particularly susceptible to inhaler technique errors and poor clinical outcomes. Several factors may influence their risk, but most studies are inconsistent and contradictory. We developed a tool for the major predictors of individual risk in these patients.

Design, Setting and Participants

In this multicentre, cross-sectional study, several demographic, socioeconomic and clinical characteristics were collected as potential predictors. Clinical features and inhaler technique performance were the main outcomes. Linear and logistic regression models were set up to identify significant variables. Subgroup analysis was performed according to age, cognitive performance and different types of inhalers.

Results

We included 130 participants, mean age of 74.4 (± 6.4) years. Mean years of device use were 5.8 (± 7.3). Inhaler errors affected 71.6% (95% CI 64–78.5) and critical mistakes 31.1% (95% CI 24–38.8). There were respiratory comorbidities in 82.3% of participants, and 56.2% had moderate to severe disease. A predictive score of misuse probability was developed for clinical practice, including points attributable to cognitive score, adherence and having received previous education on a placebo device. Other significant variables of individual risk were having respiratory allergies or comorbidities, smoking status, depression and educational level. Worse performance was detected in cognitively impaired patients older than 75 years who were using dry powder inhalers (DPI). Lung function was associated with smoking load, incorrect dose activation and absent end pause after inhalation.

Conclusions

Individual risk assessment in older individuals should focus on inhaler technique performance (mainly on dose activation and end pause) and adherence, smoking, respiratory comorbidities and cognitive impairment. Placebo device training provided by doctors seems to best suit these patients.

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Acknowledgements

The authors would like to thank Luís Teixeira, Family Doctor at Senhora de Vagos Family Health Unit and Tiago Lopes, Family Doctor at Baía Family Health Unit, for their collaboration as investigators during the conduct of the study. These colleagues were involved in the recruitment of participants and data collection only, but had no involvement in study design, data analysis or writing of this manuscript.

Author information

Authors and Affiliations

  1. Aveiro-Aradas Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal

    Tiago Maricoto & Duarte Santos

  2. Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal

    Tiago Maricoto

  3. Flor de Sal Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal

    Catarina Carvalho & Inês Teles

  4. Life and Health Sciences Research Institute (ICVS)/3B’s-PT Government Associate Laboratory, University of Minho, Braga, Portugal

    Jaime Correia-de-Sousa

  5. Horizonte Family Health Unit, ULS Matosinhos, Matosinhos, Portugal

    Jaime Correia-de-Sousa

  6. CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal

    Luís Taborda-Barata

  7. CACB-Clinical Academic Center of Beiras, Covilhã, Portugal

    Luís Taborda-Barata

  8. Department of Allergy and Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal

    Luís Taborda-Barata

  9. USF Aveiro-Aradas, Praceta Rainha D. Leonor, 3800, Aveiro, Portugal

    Tiago Maricoto

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  1. Tiago Maricoto
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Contributions

TM, LT-B and JC-S contributed on the study design, conduction and monitoring, on data analysis and manuscript review. TM contributed on patient recruitment and writing of the first draft of the manuscript. DS, CC and IT contributed on study conduction, participant recruitment, data analysis and manuscript review. LT-B and JC-S had full access to all of the data in the study and are the guarantors for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Tiago Maricoto.

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Maricoto, T., Santos, D., Carvalho, C. et al. Assessment of Poor Inhaler Technique in Older Patients with Asthma or COPD: A Predictive Tool for Clinical Risk and Inhaler Performance. Drugs Aging 37, 605–616 (2020). https://doi.org/10.1007/s40266-020-00779-6

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