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Device errors in asthma and COPD: systematic literature review and meta-analysis
Henry Chrystyn1, Job van der Palen2,3, Raj Sharma4
1Inhalation Consultancy Ltd, Yeadon, Leeds and Faculty of Human and Health Sciences, Plymouth University, Plymouth, UK. h.chrystyn@gmail.com.
NPJ Primary Care Respiratory Medicine
|April 5, 2017
Summary
Inhaler misuse is common in asthma and chronic obstructive pulmonary disease (COPD) patients, with high error rates across all devices. More research and standardized checklists are needed to improve inhaler use and patient outcomes.
Area of Science:
- Respiratory Medicine
- Clinical Pharmacy
Background:
- Inhaler device errors are prevalent and can compromise drug effectiveness in patients with asthma and chronic obstructive pulmonary disease (COPD).
- Existing systematic reviews and meta-analyses on inhaler device errors are limited and not up-to-date.
Purpose of the Study:
- To estimate overall critical and non-critical error rates for different inhaler devices.
- To evaluate factors associated with inhaler misuse in asthma and COPD patients.
- To identify gaps in the current body of evidence regarding inhaler device errors.
Main Methods:
- A systematic review and meta-analysis of studies published up to July 23, 2014.
- Searched Embase®, MEDLINE®, MEDLINE® In-Process, and CENTRAL databases.
- Included studies on adult asthma or COPD patients using metered dose inhalers and dry powder inhalers, reporting critical or overall errors.
Main Results:
- High overall and critical error rates were observed across all inhaler devices, ranging from 50-100% and 14-92%, respectively.
- Significant between-study heterogeneity (>90% I-squared statistic) indicated substantial variability.
- A trend towards higher error rates with more complex assessment steps was noted, but no consistent pattern emerged.
Conclusions:
- The current evidence base for inhaler device errors is limited, with a lack of standardized checklists.
- Insufficient evidence exists to differentiate error rates between devices or their clinical impact.
- Standardized checklists and definitions are crucial for future research to improve understanding and patient care.