The influence of mixing inhaler devices on inhaler technique in COPD

15 May 2023
Introduction: Mixing inhaler devices requiring different techniques has an adverse effect on COPD outcomes suggesting that it leads to inappropriate inhaler technique, however, empirical evidence is lacking. Aims: Compare the nature and frequency of inhaler technique errors in COPD patients prescribed with (1) a single dry powder inhaler (DPI) versus those with (2) mixed-devices [a DPI and pressurized metered dose inhaler (pMDI)]. Methods: Balanced 1:1 matching was applied, based on country of residence and DPI device type, to score DPI technique errors in patients using (1) a single DPI (n=291) or (2) DPI + pMDI (n=291). Pre-determined checklists were used for the evaluation of DPI video recordings and complemented with errors that were observed in ≥10% of patients. Results: DPI technique errors were common in both groups. Errors ‘exhalation through the device before inhalation’ and ‘no breath-hold (<6 sec.)’ were more likely to occur in the mixed-devices group (Odds Ratio: 2.30 [1.03;5.14] & 1.71 [1.15;2.54], resp. Fig 1). Conclusion: Patients with COPD reveal poor inhaler technique – currently, ‘pMDI-related errors’ in DPI use are not accounted for in existing checklists. Although in general odds ratios pointed to more errors in the mixed-devices group, the nature and frequency of errors did not significantly differ between patients using a single DPI or mixed-devices.

Resource information

Respiratory conditions
  • COPD
Respiratory topics
  • Inhalers
Type of resource
IPCRG Prize Winning Abstract
Munich 2023
Lars Dijk1, Marjan Kerkhof1, Merijn Driessen1, Yoran Gerritsma1, Sinthia Bosnic-Anticevich2,3, Jaime Correia de Sousa4, Richard Dekhuijzen5, Huib Kerstjens6, Marika Leving1, David Price7,8, Ioanna Tsiligianni9, Omar Usmani10, Janwillem Kocks1,6,11 1General Practitioners Research Institute (GPRI), Groningen, The Netherlands, 2Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia, 3Sydney Local Health District, , Australia, 4Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal, 5Radboud University Medical Center, Nijmegen, the Netherlands, 6Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands, 7Observational and Pragmatic Research Institute, Singapore, Singapore, 8Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom, 9Department of Social Medicine, Health Planning Unit, Faculty of Medicine, University of Crete, Rethymno, Greece, 10Airway Disease, National Heart and Lung Institute (NHLI), Imperial College London and Royal Brompton Hospital, London, United Kingdom, 11University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands