Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD

Anne C. Melzer, Bijan J. Ghassemieh, Suzanne E. Gillespie, Peter K. Lindenauer, Mary Ann McBurnie, Richard A. Mularski, Edward T. Naureckas, William M. Vollmer, David H. Au

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36 Scopus citations


Background Inhaled therapies are the cornerstone of pharmacologic management for COPD. Each device requires a unique series of steps to be most effective, making appropriate instruction in inhaler technique a key part of the management of COPD. Objectives Examine characteristics of patients and devices associated with poor technique among patients with COPD. Methods Cross-sectional study of subjects with COPD using at least one of: metered dose inhaler, Advair Diskus, Spiriva Handihaler, identified from the COPD Outcomes-based Network for Clinical Effectiveness and Research Translation (CONCERT) registry. Technique was assessed face-to-face using manufacturer-provided dummy inhalers, with standardized checklists for each device. We used logistic regression to model associations with poor inhaler technique, defined as an error in ≥20% of the steps, as a function of patient characteristics, with educational attainment the primary predictor. Results 688 individuals meet eligibility criteria, 65.5% had poor technique for at least one device. In adjusted analyses, Black race was associated with poor technique (OR 3.25, 95%CI 1.86–5.67) while greater than high school education was associated with decreased odds of poor technique (OR 0.35, 95%CI 0.17–0.70 for trade school/some college, OR 0.25, 95%CI 0.11–0.61 for college or more, p ≤ 0.001 for test of linear trend). The percentage of errors varied between devices, with subjects making proportionally the most errors for MDIs. Conclusions Poor inhaler technique is common among individuals with COPD, varies between devices, and is associated with race and educational attainment. Tailored educational interventions to teach inhaler technique should be part of the process of initiating and monitoring inhaled therapies.

Original languageEnglish (US)
Pages (from-to)124-130
Number of pages7
JournalRespiratory Medicine
StatePublished - Feb 1 2017

Bibliographical note

Funding Information:
This material is based upon work supported by the Department of Veterans Affairs, Health Services Research and Development (HSR&D), who provided access to data, office space, and programming and data management. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. We would like to acknowledge the other member sites of the CONCERT Consortium, without whom this project could not have been completed. Dr. Au has personally reviewed the data, understands the statistical methods employed for efficacy analysis, and confirms an understanding of this analysis, that the methods are clearly described and that they are a fair way to report the results. Dr. Melzer was supported by an institutional F-32 (HL007287) through the University of Washington Department of Pulmonary and Critical Care. Additional support was received through the VA Health Services Research and Development (HSR&D). Support for this project was also provided by the National Heart, Lung, and Blood Institute (HL101618) for the CONCERT group. The views presented are that of the researchers and do not necessary reflect those of the Department of Veterans Affairs.

Publisher Copyright:
© 2016


  • Adherence
  • Chronic obstructive pulmonary disease (COPD)
  • Inhaled therapy
  • Technique


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