Critical errors and their reported frequencies for pressurized metered-dose inhalers and dry powder inhalers26

Critical errorFrequency (% of users)Critical errorFrequency (% of users)
HandiHaler /AerolizerDiskusTurbuhaler
Failure to remove mouthpiece cap0.15Failure of priming
Actuation against teeth, lips, or tongue0.7 Failure to open the device00.650
Activation after end of inhalation5 Failure to insert the capsule9NANA
Stopped inhalation immediately after firing10 Failure to pierce the capsule3NANA
Inhalation through nose during and after actuation2Failure of loading
 Incorrect dose loadingNA7.314
 Keep inhaler inclined ≤45° from the vertical axis during loadingNANA23
 Inhaling by nose210
 Not sealing lips around mouthpiece during inhalation554
 Slow and not forceful inhalation242822
  • 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.