Critical Error Frequency and the Impact of Training with Inhalers Commonly used for Maintenance Treatment in Chronic Obstructive Pulmonary Disease

David J Collier,1,2 Pascal Wielders,3 Job van der Palen,4,5 Logan Heyes,6 Dawn Midwinter,6 Kathryn Collison,7 Andy Preece,6 Neil Barnes,1,6 Raj Sharma6 1William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK; 2Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK; 3Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, Netherlands; 4Department of Pulmonology, Medisch Spectrum Twente, Enschede, Netherlands; 5Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, Netherlands; 6Respiratory Therapy Area Unit, GlaxoSmithKline Plc., Stockley Park, Uxbridge, UK; 7Respiratory Medical Franchise, GlaxoSmithKline Plc., Research Triangle Park, Durham, NC, USACorrespondence: David J CollierWilliam Harvey Research Institute Clinical Research Centre, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UKTel +44 7961 383925 Fax +44 207 253 1901 Email d.j.collier@qmul.ac.ukIntroduction: Training in correct inhaler use, ideally in person or by video demonstration, can minimize errors but is rarely provided in clinics. This open-label, low-intervention study evaluated critical error rates with dry-powder inhalers (DPIs), before and after training, in patients with chronic obstructive pulmonary disease.Methods: Patients prescribed an inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) (ELLIPTA, Turbuhaler, or DISKUS), long-acting muscarinic antagonist (LAMA)/LABA (ELLIPTA or Breezhaler), or LAMA-only DPI (ELLIPTA, HandiHaler, or Breezhaler) were enrolled. Critical errors were assessed before training (Visit 1 [V1]; primary endpoint) and 6 weeks thereafter (Visit 2 [V2]; secondary endpoint). Logistic regression models were used to calculate odds