Evidence map›Paper›PMID 38135462›Full record

ArticleBMJ open respiratory research2023

Does mixing inhaler devices lead to unchecked inhaler technique errors in patients with COPD? Findings from the cross-sectional observational MISMATCH study.

Lars Dijk, Marjan Kerkhof, Merijn Driessen, Yoran H Gerritsma, Sinthia Bosnic-Anticevich, Jaime Correia-de-Sousa, P N Richard Dekhuijzen, Marika Leving, David B Price, Ioanna Tsiligianni and 3 more

Open access · goldAbstract read
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In one paragraph

Article in BMJ open respiratory research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.0field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 4 citations in OpenAlex.

  1. Behavioral Phenotypes of Inhaler Technique and Adherence in COPD: A Cross-Sectional Study.International journal of chronic obstructive pulmonary disease · 2026
    Article
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 8 institutions in 6 countries.

Lars DijkGeneral Practitioners Research Institute, Groningen, The Netherlands.ORCID 0000-0002-9544-1487
Marjan KerkhofGeneral Practitioners Research Institute, Groningen, The Netherlands.
Merijn DriessenGeneral Practitioners Research Institute, Groningen, The Netherlands.ORCID 0000-0002-1784-0642
Yoran H GerritsmaGeneral Practitioners Research Institute, Groningen, The Netherlands.
Sinthia Bosnic-AnticevichMacquarie University, Sydney, New South Wales, Australia.
Jaime Correia-de-SousaLife and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.
P N Richard DekhuijzenRadboud University Nijmegen, Nijmegen, The Netherlands.
Marika LevingGeneral Practitioners Research Institute, Groningen, The Netherlands.
David B PriceCentre of Academic Primary Care, Division of Applied Health Sciences, Univ Aberdeen, Aberdeen, UK.
Ioanna TsiligianniDepartment of Social Medicine, Health Planning Unit, Faculty of Medicine, University of Crete, Rethimno, Greece.
Omar UsmaniAirway Disease, National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
Huib A M KerstjensDepartment of Pulmonology, University Medical Center, Groningen, The Netherlands.
Janwillem W H KocksGeneral Practitioners Research Institute, Groningen, The Netherlands janwillem@gpri.nl.
General Practitioners Research Institute · NLUniversity Medical Center Groningen · NLImperial College London · GBRadboud University Nijmegen · NLThe University of Sydney · AUUniversity of Aberdeen · GBUniversity of Crete · GRUniversity of Minho · PT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients with chronic obstructive pulmonary disease (COPD) may be prescribed multiple inhalers that require different techniques for optimal performance. Mixing devices has been associated with poorer COPD outcomes suggesting that it leads to inappropriate inhaler technique. However, empirical evidence is lacking.

aimsCompare the nature and frequency of dry powder inhaler (DPI) technique errors in patients with COPD using (1) a single DPI or (2) mixed-devices (a DPI and pressurised metered dose inhaler (pMDI)).

methodsData from the PIFotal study-a cross-sectional study on Peak Inspiratory Flow in patients with COPD using a DPI as maintenance therapy, capturing data from 1434 patients on demographic characteristics, COPD health status and inhaler technique-were used to select 291 patients using mixed-devices. Frequency matching based on country of residence and DPI device type was used to select 291 patients using a DPI-only for comparison. Predetermined checklists were used for the evaluation of DPI video recordings and complemented with additional errors that were observed in ≥10%. Error proportions were calculated for the (1) individual and total number of errors, (2) number of critical errors and (3) number of pMDI-related errors.

resultsThe study sample contained 582 patients (mean (SD) age 69.6 (9.4) years, 47.1% female). DPI technique errors were common, but not significantly different between the groups. The majority of patients made at least one critical error (DPI-only: 90.7% vs mixed-devices: 92.8%). Proportions of total, 'pMDI-related' and critical errors did not significantly differ between the groups.

conclusionThe nature and frequency of inhaler technique errors did not substantially differ between patients prescribed with a single DPI and mixed-devices. Currently, 'pMDI-related errors' in DPI use are not accounted for in existing checklists. TRIAL REGISTRATION NUMBER: ENCEPP/EUPAS48776.

Indexed as

Pulmonary Disease, Chronic ObstructiveAdministration, InhalationAgedCross-Sectional StudiesDry Powder InhalersFemaleHumansMaleMetered Dose InhalersCOPD PharmacologyInhaler devicesPulmonary Disease, Chronic Obstructive

Identifiers

PMID38135462
OpenAlexW4390101591

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.