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Table of Contents
Vol. 75, No. 1, 2008
Issue release date: January 2008
Section title: Clinical Investigations
Respiration 2008;75:18–25
(DOI:10.1159/000109374)

Dry Powder Inhalers: Which Factors Determine the Frequency of Handling Errors?

Wieshammer S.a · Dreyhaupt J.b
aPneumologisch-Thoraxchirurgisches Zentrum, Klinikum Offenburg, Offenburg, and bInstitut für Medizinische Biometrie und Informatik, Universität Heidelberg, Heidelberg, Germany

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Article / Publication Details

First-Page Preview
Abstract of Clinical Investigations

Received: March 19, 2007
Accepted: June 28, 2007
Published online: October 02, 2007
Issue release date: January 2008

Number of Print Pages: 8
Number of Figures: 4
Number of Tables: 2

ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)

For additional information: http://www.karger.com/RES

Abstract

Background: Dry powder inhalers are often used ineffectively, resulting in a poor level of disease control. Objectives: To determine how often essential mistakes are made in the use of Aerolizer®, Discus®, HandiHaler® and Turbuhaler® and to study the effects of age, severity of airflow obstruction and previous training in inhalational technique by medical personnel on the error rate. Methods: Two hundred and twenty-four newly referred outpatients (age 55.1 ± 20 years) were asked how they had been acquainted with the inhaler and to demonstrate their inhalational technique. Results: The inhaler-specific error rates were as follows: Aerolizer 9.1%, Discus 26.7%, HandiHaler 53.1% and Turbuhaler 34.9%. Compared to Aerolizer, the odds ratio of an ineffective inhalation was higher for HandiHaler (9.82, p < 0.01) and Turbuhaler (4.84, p < 0.05). The error rate increased with age and with the severity of airway obstruction (p < 0.01). When training had been given as opposed to no training, the odds ratio of ineffective inhalation was 0.22 (p < 0.01). If Turbuhaler is used, the estimated risks range from 9.8% in an 18-year-old patient with normal lung function and previous training to 83.2% in an 80-year-old patient with moderate or severe obstruction who had not received any training. Conclusions: Dry powder inhalers are useful in the management of younger patients with normal lung function or mild airway obstruction. In older patients with advanced chronic obstructive pulmonary disease, the risk of ineffective inhalation remains high despite training in inhalational technique. A metered-dose inhaler with a spacer might be a valuable treatment alternative in a substantial proportion of these patients.

© 2007 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Clinical Investigations

Received: March 19, 2007
Accepted: June 28, 2007
Published online: October 02, 2007
Issue release date: January 2008

Number of Print Pages: 8
Number of Figures: 4
Number of Tables: 2

ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)

For additional information: http://www.karger.com/RES


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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