Inhaler devices in asthma and COPD--an assessment of inhaler technique and patient preferences

Respir Med. 2014 Jul;108(7):968-75. doi: 10.1016/j.rmed.2014.04.019. Epub 2014 May 10.


Background: Incorrect use of inhaler devices remains an obstacle for respiratory diseases management. We aimed to evaluate the frequency of inhaler technique errors; to determine the devices perceived as the easiest and favourite to use; to study the association of device type, demographics and patient preferences with inhaler technique (IT).

Methods: Cross-sectional assessment of 301 adults, with asthma (194) or chronic pulmonary obstructive disease, undergoing treatment with Aerolizer®, Autohaler®, Breezehaler®, Diskus®, Handihaler®, MDI without spacer, Miat-haler®, Novolizer®, Respimat® and/or Turbohaler®. Patients completed self-assessment questionnaires and face-to-face interview, with demonstration of inhaler technique. The rate of wrong steps (number of wrong steps ÷ number of total steps; RWS) was the primary outcome. Adjusted odds ratio (aOR) (95% confidence intervals [CI]) for presenting ≥1 IT errors were computed.

Results: From the 464 inhaler technique performances, the median RWS was 18%. Turbohaler® (21%) and Diskus® (19%) were chosen as easiest and Novolizer® (18%), Diskus® (18%), Turbohaler® (17%) as favourite for daily use. Females (aOR 2.68 [95% CI 1.55-4.65]; vs. males], patients with >64 yr (aOR 2.73 [95% CI 1.15-6.48]; vs <45 yr) and patients using Aerolizer® or Handihaler® (aOR 3.24 [95% CI 1.13-9.32] and aOR 3.71 [95% CI 1.38-10.2], respectively) were more likely to perform IT errors; otherwise, no association was found, including with using the favourite device (aOR 1.43 [95% CI 0.84-2.42]).

Conclusion: The frequency of inhaler technique errors was high and no device was clearly preferred over the others. Using the preferred inhaler device was not associated with less errors.

Keywords: Asthma; COPD; Inhaler device; Inhaler technique; Patient preference.

Publication types

  • Observational Study

MeSH terms

  • Administration, Inhalation
  • Adult
  • Aged
  • Asthma / drug therapy*
  • Asthma / psychology
  • Cross-Sectional Studies
  • Educational Status
  • Equipment Design
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Middle Aged
  • Nebulizers and Vaporizers*
  • Patient Preference*
  • Portugal
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Self Administration / instrumentation
  • Self Administration / standards