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The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients
Background Incorrect inhaler use is associated with poorer health outcomes, reduced quality of life, and higher healthcare utilisation in patients with asthma and COPD. Method We performed an observational study of pressurized metered-dose inhaler technique in patients with asthma or COPD. Patients...
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| Format: | Thesis |
| Language: | English |
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Department of Medicine
2021
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| _version_ | 1867613630257692672 |
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| access_status_str | Open Access |
| author | Perumal, Rubeshan |
| author2 | Van Zyl-Smit, Richard |
| author_browse | Perumal, Rubeshan Van Zyl-Smit, Richard |
| author_facet | Van Zyl-Smit, Richard Perumal, Rubeshan |
| author_sort | Perumal, Rubeshan |
| collection | Thesis |
| description | Background Incorrect inhaler use is associated with poorer health outcomes, reduced quality of life, and higher healthcare utilisation in patients with asthma and COPD. Method We performed an observational study of pressurized metered-dose inhaler technique in patients with asthma or COPD. Patients were assessed using a six-point inhaler checklist to identify common critical inhaler technique errors. An inadequate inhaler technique was defined as the presence of one or more critical errors. A multivariate logistic regression model was used to determine the odds of an inadequate inhaler technique. Results During the 14-month study period, 357 patients were enrolled. At least one critical error was executed by 66.7% of participants, and 24.9% made four or more critical errors. The most common errors were: failure to exhale completely prior to pMDI activation and inhalation (49.6%), failure to perform a slow, deep inhalation following device activation (48.7%), and failure to perform a breathhold at the end of inspiration (47.3%). The risk of a critical error was higher in COPD patients (aOR 2.25, 95%CI 1.13 – 4.47). Prior training reduced error risk specifically when trained by a doctor (aOR 0.08, 95% CI 0.1 – 0.57) or a pharmacist (aOR 0.02, 95% CI 0.01 – 0.26) compared to those with no training. Previous clinical trial participation significantly reduced error risk and rate:< 3 trials (aOR 0.35, 95% CI 0.19 – 0.66) and ≥3 trials (aOR 0.17, 95% CI 0.07 – 0.42). The rate of critical errors was not significantly associated with age, sex, or prior pMDI experience. Conclusion This study found a high rate of critical inhaler technique errors in a mixed population of asthma and COPD patients; however, prior training and in particular, multiple previous clinical trial participation significantly reduced the risk of errors. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/33928 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:39:12.147Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2021 |
| publishDateRange | 2021 |
| publishDateSort | 2021 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/33928 The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients Perumal, Rubeshan Van Zyl-Smit, Richard Pulmonology Background Incorrect inhaler use is associated with poorer health outcomes, reduced quality of life, and higher healthcare utilisation in patients with asthma and COPD. Method We performed an observational study of pressurized metered-dose inhaler technique in patients with asthma or COPD. Patients were assessed using a six-point inhaler checklist to identify common critical inhaler technique errors. An inadequate inhaler technique was defined as the presence of one or more critical errors. A multivariate logistic regression model was used to determine the odds of an inadequate inhaler technique. Results During the 14-month study period, 357 patients were enrolled. At least one critical error was executed by 66.7% of participants, and 24.9% made four or more critical errors. The most common errors were: failure to exhale completely prior to pMDI activation and inhalation (49.6%), failure to perform a slow, deep inhalation following device activation (48.7%), and failure to perform a breathhold at the end of inspiration (47.3%). The risk of a critical error was higher in COPD patients (aOR 2.25, 95%CI 1.13 – 4.47). Prior training reduced error risk specifically when trained by a doctor (aOR 0.08, 95% CI 0.1 – 0.57) or a pharmacist (aOR 0.02, 95% CI 0.01 – 0.26) compared to those with no training. Previous clinical trial participation significantly reduced error risk and rate:< 3 trials (aOR 0.35, 95% CI 0.19 – 0.66) and ≥3 trials (aOR 0.17, 95% CI 0.07 – 0.42). The rate of critical errors was not significantly associated with age, sex, or prior pMDI experience. Conclusion This study found a high rate of critical inhaler technique errors in a mixed population of asthma and COPD patients; however, prior training and in particular, multiple previous clinical trial participation significantly reduced the risk of errors. 2021-09-15T16:00:06Z 2021-09-15T16:00:06Z 2020 2021-09-15T02:09:50Z Master Thesis Masters MPhil http://hdl.handle.net/11427/33928 eng application/pdf Department of Medicine Faculty of Health Sciences |
| spellingShingle | Pulmonology Perumal, Rubeshan The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients |
| thesis_degree_str | Master's |
| title | The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients |
| title_full | The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients |
| title_fullStr | The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients |
| title_full_unstemmed | The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients |
| title_short | The relationship between clinical trial participation and inhaler technique errors in asthma and COPD patients |
| title_sort | relationship between clinical trial participation and inhaler technique errors in asthma and copd patients |
| topic | Pulmonology |
| url | http://hdl.handle.net/11427/33928 |
| work_keys_str_mv | AT perumalrubeshan therelationshipbetweenclinicaltrialparticipationandinhalertechniqueerrorsinasthmaandcopdpatients AT perumalrubeshan relationshipbetweenclinicaltrialparticipationandinhalertechniqueerrorsinasthmaandcopdpatients |