Study finds direct link between specific inhaler errors and asthma outcomes

A new study published in the Journal of Allergy and Clinical Immunology: In Practice highlights important findings from the international CRITIKAL study (CRITical Inhaler mistaKes and Asthma controL). CRITIKAL is the first study to assess the associations between specific inhaler errors and poorer asthma outcomes in patients receiving a fixed-dose combination treatment with inhaled corticosteroids and long-acting beta agonist (ICS/LABA) via dry-powder inhalers (DPIs) and metered-dose inhalers (MDIs). The CRITIKAL analysis used data from 3,660 patients included in the iHARP asthma review service (initiative Helping Asthma in Real-life Patients) – a multi-centre, cross-sectional review of over 5,000 adults with asthma delivered by Optimum Patient Care ( This was an investigator initiated trial with data analysis undertaken by the Observational and Pragmatic Research Institute in collaboration with members of the Respiratory Effectiveness Group and part-funded by a grant from Mundipharma Research Limited.  

“When managing asthma, our aim is to reduce the risk of exacerbations and control patients’ symptoms. If patients are not aware how to use their inhaler devices correctly, the effectiveness of their treatment is diminished, which can lead to poorly controlled asthma impacting the patient’s quality of life and can also lead to unnecessary costs to healthcare systems. The real-world CRITIKAL study identified the specific critical inhaler errors that are frequent and impact asthma outcomes. This study could help routine patient management by targeting training to reduce these critical errors with the aim of improving overall patient outcomes,” said Professor David Price, Chair of Primary Care Respiratory Medicine at the University of Aberdeen, Aberdeen, UK, Director of the Observational and Pragmatic Research Institute and ex-Chairman of the Respiratory Effectiveness Group.

The results of the CRITIKAL analysis showed that certain errors were frequent, made by over 30% of patients in some cases, and associated with poor asthma control. Some errors were device-specific whereas others were generic across devices.

Previous studies have shown that poor or improper inhaler technique in asthma is associated with reduced control and an increase in hospital visits. However, these results provide crucial insights into which specific inhaler errors are linked to poor asthma outcomes (including increased likelihood of having uncontrolled symptoms and increased exacerbation rate). The study highlights that choosing the right inhaler type for each patient along with training by primary and secondary healthcare management teams is needed to help reduce the number of critical inhaler errors and ultimately improve patient health.



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