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Presentation transcript:

Inhaler Errors in the CRITIKAL Study: Type, Frequency, and Association with Asthma Outcomes David B. Price, FRCGP, Miguel Román-Rodríguez, MD, R. Brett McQueen, PhD, Sinthia Bosnic-Anticevich, BPharm (Hons), PhD, Victoria Carter, BSc, Kevin Gruffydd-Jones, BM BCh, FRCGP, John Haughney, FRCPE, FRCGP, Svein Henrichsen, MD, Catherine Hutton, BA, Antonio Infantino, MD, Federico Lavorini, MD, PhD, Lisa M. Law, MSc, Karin Lisspers, MD, PhD, Alberto Papi, MD, Dermot Ryan, MD, Björn Ställberg, MD, PhD, Thys van der Molen, MD, PhD, Henry Chrystyn, Phd, FRPHarmS The Journal of Allergy and Clinical Immunology: In Practice Volume 5, Issue 4, Pages 1071-1081.e9 (July 2017) DOI: 10.1016/j.jaip.2017.01.004 Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 1 Association between inhaler errors (for DPIs) and uncontrolled asthma. Note. Errors omitted despite a significant univariable association were omitted because they were correlated with another error. BMI, Body mass index; Ref, reference group in logistic regression. *Patient factors used to adjust were age, sex, smoking status, BMI, rhinitis, and paracetamol use. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1071-1081.e9DOI: (10.1016/j.jaip.2017.01.004) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 2 Association between inhaler errors (for MDI) and uncontrolled asthma. BMI, Body mass index; Ref, reference group in logistic regression. *Patient factors used to adjust were age, sex, smoking status, BMI, rhinitis, and paracetamol use. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1071-1081.e9DOI: (10.1016/j.jaip.2017.01.004) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 3 Association between inhaler errors (for DPIs) and rate of exacerbations. BMI, Body mass index; Ref, reference group in Poisson regression. *Patient factors used to adjust were age, sex, smoking status, BMI, rhinitis, and paracetamol use. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1071-1081.e9DOI: (10.1016/j.jaip.2017.01.004) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 4 Association between inhaler errors (for MDI) and rate of exacerbations. BMI, Body mass index; Ref, reference group in Poisson regression. *Patient factors used to adjust were age, sex, smoking status, BMI, rhinitis, and paracetamol use. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1071-1081.e9DOI: (10.1016/j.jaip.2017.01.004) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure E1 Flow diagram showing study cohorts derived from the iHARP database. FDC ICS/LABA, Fixed-dose combination with inhaled corticosteroids/long-acting beta agonist; LTRA, leukotriene receptor antagonist. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1071-1081.e9DOI: (10.1016/j.jaip.2017.01.004) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure E2 Association between inhaler errors and uncontrolled asthma, further adjusted by patient adherence, for DPIs. BMI, Body mass index; Ref, reference group in Poisson regression. *Adjusted by all errors in figure + patient factors (age, sex, smoking status, BMI, rhinitis, and paracetamol use) + MARS score. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1071-1081.e9DOI: (10.1016/j.jaip.2017.01.004) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure E3 Association between inhaler errors and uncontrolled asthma, further adjusted by patient adherence, for MDI. BMI, Body mass index; Ref, reference group in Poisson regression. *Adjusted by all errors in figure + patient factors (age, sex, smoking status, BMI, rhinitis, and paracetamol use) + MARS score. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1071-1081.e9DOI: (10.1016/j.jaip.2017.01.004) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure E4 Association between inhaler errors and rate of exacerbations, further adjusted by patient adherence, for DPIs. BMI, Body mass index; Ref, reference group in Poisson regression. *Adjusted by all errors in figure + patient factors (age, sex, smoking status, BMI, rhinitis, and paracetamol use) + MARS score. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1071-1081.e9DOI: (10.1016/j.jaip.2017.01.004) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure E5 Association between inhaler errors and rate of exacerbations, further adjusted by patient adherence, for MDI. BMI, Body mass index; Ref, reference group in Poisson regression. *Adjusted by all errors in figure + patient factors (age, sex, smoking status, BMI, rhinitis, and paracetamol use) + MARS score. The Journal of Allergy and Clinical Immunology: In Practice 2017 5, 1071-1081.e9DOI: (10.1016/j.jaip.2017.01.004) Copyright © 2017 American Academy of Allergy, Asthma & Immunology Terms and Conditions