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DOI: https://doi.org/10.4046/trd.2020.0021    [Accepted]
Published online September 28, 2020.
Comparison of inhaler use technique based on inhaler type in elderly patients with respiratory disease
Ha Youn Lee, 1, Jin Hwa Song, 2, Ha-Kyeong Won, 2, Yeonkyung Park, 2, Keun Bum Chung, 2, Hyo-Jeong Lim, 2, Young Mee Ahn, 2, Byoung Jun Lee, MD2
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Serim General Hospital, Incheon, Republic of Korea
2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
Correspondence:  Byoung Jun Lee, Tel: +82-2-2225-1387, Fax: +82-2-487-9586, 
Email: byoungjlee@gmail.com
Received: 4 March 2020   • Revised: 6 June 2020   • Accepted: 28 September 2020
Abstract
Background
We aimed to investigate inhaler device handling in elderly patients. Furthermore, we compared inhaler devices with respect to misuse and error correction.
Methods
Inhaler use technique was assessed using standardized checklists at the first and 3-months follow-up visits after retraining. The primary outcome was differences in the acceptable use ratio among inhaler devices. Secondary outcomes included differences in error correction, most common step of misuse, and factors affecting the accuracy of inhaler use.
Results
A total of 251 patients (mean age, 76.4) were included and the handling of 320 devices was assessed in the study. All patients had been trained before, but only 24.7% of them used inhalers correctly. Proportions of acceptable user for Evohaler®, Respimat®, Turbuhaler®, Ellipta®, and Breezhaler®/Handihaler® were 38.7%, 50.0%, 61.4%, 60.8%, and 43.2%, respectively (p=0.026). At the second visit, the acceptable user ratio had increased, and there were no significant differences among inhaler types (Evohaler®, 63.9%; Respimat®, 86.1%; Turbuhaler®, 74.3%; Ellipta®, 64.6%; and Breezhaler®/Handihaler®, 65.3% [p=0.129]). In multivariate analysis, BMI, Turbuhaler®, and Ellipta® showed a positive correlation with the acceptable use of inhalers, whereas the CAT score showed a negative correlation.
Conclusion
New inhalers have been developed, but the accuracy of inhaler use remains low. Elderly patients showed more errors when using pressurized metered-dose inhalers compared to dry powder inhalers and soft mist inhalers. However, there were no differences in misuse among inhaler devices after individual training. The result of this study suggests that repeat training is more important than inhaler type.
Key Words: Inhaler, Chronic obstructive pulmonary disease, Asthma, Aged


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