Critical errors and their reported frequencies for pressurized metered-dose inhalers and dry powder inhalers26
| pMDIs | DPIs | ||||
|---|---|---|---|---|---|
| Critical error | Frequency (% of users) | Critical error | Frequency (% of users) | ||
| HandiHaler /Aerolizer | Diskus | Turbuhaler | |||
| Failure to remove mouthpiece cap | 0.15 | Failure of priming | |||
| Actuation against teeth, lips, or tongue | 0.7 | Failure to open the device | 0 | 0.65 | 0 |
| Activation after end of inhalation | 5 | Failure to insert the capsule | 9 | NA | NA |
| Stopped inhalation immediately after firing | 10 | Failure to pierce the capsule | 3 | NA | NA |
| Inhalation through nose during and after actuation | 2 | Failure of loading | |||
| Incorrect dose loading | NA | 7.3 | 14 | ||
| Keep inhaler inclined ≤45° from the vertical axis during loading | NA | NA | 23 | ||
| Inhaling by nose | 2 | 1 | 0 | ||
| Not sealing lips around mouthpiece during inhalation | 5 | 5 | 4 | ||
| Slow and not forceful inhalation | 24 | 28 | 22 | ||
Abbreviations: DPI, dry powder inhaler; NA, not applicable; pMDI, pressurized metered-dose inhaler.
Reprinted from Respiratory Medicine, 105(6). Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control, 930–938, Copyright 2011, with permission from Elsevier.