The online version of this article (https://doi.org/10.1186/s12931-017-0710-y) contains supplementary material, which is available to authorized users.
Inhaled drug delivery is the cornerstone treatment for asthma and chronic obstructive pulmonary disease (COPD). However, use of inhaler devices can be challenging, potentially leading to critical errors in handling that can significantly reduce drug delivery to the lungs and effectiveness of treatment.
A systematic review was conducted to define ‘critical’ errors and their impact on health outcomes and resource use between 2004 and 2016, using key search terms for inhaler errors in asthma and COPD (Search-1) and associated health-economic and patient burden (Search-2).
Search-1 identified 62 manuscripts, 47 abstracts, and 5 conference proceedings (n = 114 total). Search-2 identified 9 studies. We observed 299 descriptions of critical error. Age, education status, previous inhaler instruction, comorbidities and socioeconomic status were associated with worse handling error frequency. A significant association was found between inhaler errors and poor disease outcomes (exacerbations), and greater health-economic burden.
We have shown wide variations in how critical errors are defined, and the evidence shows an important association between inhaler errors and worsened health outcomes. Given the negative impact diminished disease outcomes impose on resource use, our findings highlight the importance of achieving optimal inhaler technique, and a need for a consensus on defining critical and non-critical errors.
Additional file 1: One supplementary file is associated with this manuscript: “Online Resource – Critical handling errors in asthma and COPD: A systematic review of impact on health outcomes”. This contains: search strategies and details of the analysis conducted within this literature review (Table S1); a breakdown of grouped critical errors described in the literature for different inhaler device types (Table S2); summaries of pre-existing known publications that show associations between poor disease control, economic burden and poor QoL (Table S3); definitions of a ‘critical’ error provided by studies captured within the literature review (Table S4). This file is named: “Critical handling errors data supplement update v8_0”. (DOCX 588 kb)12931_2017_710_MOESM1_ESM.docx
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- Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes
Omar Sharif Usmani
William Christopher Nigel Dunlop
- BioMed Central
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