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oai:repisalud.isciii.es:20.500.12105/236792024-11-29T02:47:03Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16967

00925njm 22002777a 4500 dc Kocks, Janwillem author Bosnic-Anticevich, Sinthia author van Cooten, Joyce author Correia de Sousa, Jaime author Cvetkovski, Biljana author Dekhuijzen, Richard author Dijk, Lars author Garcia Pardo, Marina author Gardev, Asparuh author Gawlik, Radosław author van der Ham, Iris author Janse, Ymke author Lavorini, Federico author Maricoto, Tiago author Meijer, Jiska author Metz, Boyd author Price, David author Roman-Rodriguez, Miguel author Schuttel, Kirsten author Stoker, Nilouq author Tsiligianni, Ioanna author Usmani, Omar author Voorham, Jaco author Leving, Marika T author 2023-08-17 Background: Correct inhaler use depends on a complex interplay of factors, including device preparation and generating sufficient inspiratory flow. It is currently unknown which inhalation technique errors can be considered critical in Chronic Obstructive Pulmonary Disease (COPD) patients on Dry Powder Inhaler (DPI) maintenance therapy. Objective: To investigate the association between inhalation technique errors and health status or exacerbations in patients with COPD. Additionally, the association between the number of errors and COPD outcomes was determined. Methods: The PIFotal study is a cross-sectional multi-country observational study in a primary care setting, including 1434 COPD patients aged ≥ 40 years (50.1% female; mean age 69.2 yrs) using a DPI for their maintenance therapy. Inhalation technique was video recorded and scored by two independent researchers using inhaler-specific checklists. Health status was assessed with two questionnaires; the Clinical COPD Questionnaire (CCQ) and the COPD Assessment Test (CAT). The number of moderate and severe exacerbations in the past 12 months was recorded. Critical errors were identified based on their association with health status or exacerbations through multi-level prediction models adjusted for identified confounding. Results: Errors in inhalation technique steps 'Breathe in', 'Hold breath', and 'Breathe out calmly after inhalation' were significantly associated with poorer CCQ and CAT outcomes and thus deemed critical. None of the errors were significantly associated with moderate exacerbations. Patients with errors 'Preparation', 'Hold inhaler in correct position during inhalation', and 'Breathe in' had significantly more severe exacerbations, and therefore these errors were also deemed critical. 81.3% of patients with COPD made at least one critical error. Specific combinations of errors were associated with worse outcomes. The more inhalation technique errors identified, the poorer the health status and the higher the exacerbation rate. Conclusion: In this study, we identified multiple critical inhalation technique errors in COPD patients using DPIs each associated with poorer outcomes. Explorative analysis revealed that specific combinations of errors may be of clinical relevance, especially those related to the inhalation manoeuvre. COPD outcomes worsened with increasing error count. These results warrant further prospective longitudinal studies to establish the effect of correcting these errors on COPD control. Trial registration: https://clinicaltrials.gov/ct2/show/NCT04532853 (31/08/2020). Kocks J, Bosnic-Anticevich S, van Cooten J, Correia de Sousa J, Cvetkovski B, Dekhuijzen R, et al. Identifying critical inhalation technique errors in Dry Powder Inhaler use in patients with COPD based on the association with health status and exacerbations: findings from the multi-country cross-sectional observational PIFotal study. BMC Pulm Med. 2023 Aug 17;23(1):302. 10.1186/s12890-023-02566-6 1471-2466 BMC pulmonary medicine https://hdl.handle.net/20.500.13003/19926 37592263 L2024925137 2-s2.0-85168290405 https://hdl.handle.net/20.500.12105/23679 1051781100001 Identifying critical inhalation technique errors in Dry Powder Inhaler use in patients with COPD based on the association with health status and exacerbations: findings from the multi-country cross-sectional observational PIFotal study