Can the individual socioeconomic position influence the occurrence of critical errors in inhalation technique?

Institute of Biomedical Sciences, University of Porto, Porto, Portugal Research question: Can the individual socioeconomic position influence the occurrence of critical errors in inhalation technique? Background: Socioeconomic position (SEP) is one of the most important determinants of health, with people with lower SEP tending to have worse health outcomes compared with those with higher SEP. Inhaled therapy is crucial in COPD management, offering symptom relief and improving quality of life. A correct inhalation technique is essential for effective treatment, maximizing benefits while minimising potential side effects. In previous studies, lower socioeconomic position has been associated with a higher likelihood of incorrect inhalation technique in COPD and asthma patients. Are primary care physicians aware of health inequities in persons with COPD? Do they recognise and understand the socioeconomic mechanisms related with worse health outcomes? Is there an association between SEP and adequate inhalation technique in persons with COPD? Methodology: Between October 2020 and May 2021, a population-based sample of 206 patients registered in 12 practices of the Portuguese National Health Service was recruited for the PIFotal study (ClinicalTrials.gov: NCT04532853). Eligible participants were COPD patients aged 40 years using dry powder inhaler (DPI) devices for maintenance therapy. Socioeconomic and clinical data were collected through questionnaires. Inhalation technique was assessed by standardised evaluation of video recordings. Exposures: individual highest obtained educational level, gender, marital status, unemployment, neighbourhood disadvantage based on the practice location. Outcome variable: total number of errors / total number of critical errors. Co-variates: Clinical COPD Questionnaire results, Test of Adherence to Inhalers questionnaire, co-morbidities (such as concomitant asthma), body mass index. Multivariate (and if necessary, multilevel) statistical models will be developed to explore the association between individual socioeconomic position indicators and the occurrence of errors in dry powder Inhaler technique. Questions to discuss: Is there an effect of SEP on DPI inhalation technique errors?