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Objectives: This study evaluated Dry Powder Inhaler (DPI) and Metered-Dose Inhaler (MDI) use in older patients to better identify errors and barriers to proper inhaler technique.
Study Design: All patients in a geriatric continuum of care (outpatient facility, subacute care center and a long-term skilled nursing facility) currently self-administering a respiratory inhaler, were offered participation through informed consent between 9/1/15-12/1/15
Methods: Demographics, number, type and dose of inhaler(s), and duration of inhaler use, were collected via survey. A pharmacist recorded direct observation of patient’s technique, using placebo inhalers.
Results: There were 32 subjects recruited; average age 81 (range: 67-96 years). Most, (63%), had COPD, 39% had asthma, 7% had both. Most (89%) had at least one maintenance inhaler, 33% had two or more, and 41% had one or more rescue inhalers, and 70% had been using an inhaler for at least a year. The survey documented reported ease of use by most participants (84%), and 69% reported previous training. Yet, during direct observation by a pharmacist, 67% demonstrated errors for MDI (simultaneous actuation and inhalation [80%], breathing out fully before inhalation [60%], and holding their breath after inhalation [60%]), and 71% for DPI (using the mouthpiece correctly [88%], and breathing out fully away from the inhaler [63%], and using the dose counter correctly [56%]). Finally, 73% required reeducation on their inhaler technique.
There were no significant differences reported between gender, age, disease type, previous training, or clinical setting.
Conclusions: This study suggests that older patients with COPD and asthma commonly use their inhalers incorrectly, despite their reported long term experience with inhaler use. Identification of common types of errors in inhaler technique may help health care professionals to better focus their education efforts, in successfully managing their older patients.