Inhaler Use in COPD Patients: A Cross-sectional Study, Critical Errors and Optimal Peak Inspiratory Flow measured with the InCheck Dial Device.

This study evaluates inhaler technique, critical errors, and peak inspiratory flow in COPD elderly patients (>65 years) compared to younger counterparts for different devices (pMDI, DPI, SMI). The study, spanning from Nov 2021 to Nov 2023 at Shaare Zedek Medical Center, assessed 81 COPD patients. In this study 41 patients (51.2%) were >65 years old. The mean ages were 58.0 (6.4) and 73.3 (5.3) years for the younger and older groups, respectively. Smoking rates were 42.5% in the younger and 21.9% in the older group. FEV1/FVC% was 58.1 (13.9) and 52.6 (10.8) in the younger and older groups, respectively. Exacerbation rates were 0.7 (1.2) and 1.5 (1.6) for the younger and older groups, respectively. Half of each group used home oxygen. Inhaler use varied: 42.5% of younger and 34.1% of older patients used one device, 40% and 36.6% used two, and 17.5% and 29.3% used three or more devices. <bold>Inhaler Technique:</bold> Younger patients demonstrated high mean (SD) NHS scores across all categories [DPI=5.75 (0.89); MDI=5.83 (0.94); SMI=6.33 (1.15)]. Older patients had significantly lower scores for pMDI [3.75 (1.9)] compared to DPI [5.70 (0.14)] and SMI [5.29 (1.4)] (p=0.000). Between-group analysis indicated significantly lower scores for MDI and Class 1 inhalers in the older group (p=0.0001). <bold>Critical Errors:</bold> Intra-group analysis showed no difference in critical errors (CE) percentages within the younger group. Older patients had higher CE percentages, ranging from 28.3% (DPI) to 57.1% (pMDI) (p=0.05). Peak Inspiratory Flow Efficiency: Both groups generated sufficient peak inspiratory flow for inhaler activation.