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Table 4 Frequency of HCP-observed errors after 12 weeks of device use in the longitudinal phase

From: Evaluation of inhaler technique and achievement and maintenance of mastery of budesonide/formoterol Spiromax® compared with budesonide/formoterol Turbuhaler® in adult patients with asthma: the Easy Low Instruction Over Time (ELIOT) study

  BF Spiromax (N = 151) BF Turbuhaler (N = 154)
Number of patients with at least one error, n (%) 62 (41.1%) 72 (46.8%)
Total errors, n 75a 125a
 Does not hold the inhaler with the semi-transparent mouthpiece cover at the bottom 0 N/A
 Spiromax: Does not open cap  Turbuhaler: Does not remove cap 0 0
 Dose preparation: A click is not heard when the cap is opened 0 N/A
 Dose preparation: not twisting the base as far as possible, until it clicks and not turning it back to the original position N/A 19 (12.3%)
 Spiromax: Inhaler is not held upright when a dose is prepared (±90° is acceptable)  Turbuhaler: Inhaler is not held upright (mouthpiece skywards ±45°) when a dose is prepared throughout dose preparation 4 (2.6%) 8 (5.2%)
 Turbuhaler: Device not held upright (upright means mouthpiece pointed skywards ±45°) after the base is twisted until inhalation N/A 8 (5.2%)
 Vigorous shaking before or after dose preparation 19 (12.6%) 18 (11.7%)
 Exhales into the inhaler before taking dose 8 (5.3%) 13 (8.4%)
 Fails to put in mouth and seal lips around mouthpiece 1 (0.7%) 1 (0.6%)
 Spiromax: Finger (or face) placed over the air inlet during an inhalation (at front above the mouthpiece)  Turbuhaler: Fingers or mouth placed around air inlets (positioned around the base and above the mouthpiece) 2 (1.3%) 10 (6.5%)
 Inhalation is not as fast as possible (from the start) 25 (16.6%) 22 (14.3%)
Errors involving a second dose error, n
 Spiromax: Does not close cap after the inhalation and load a new dose; a click is not heard when the cap is opened  Turbuhaler: Does not load a new dose as described; dose preparation: not twisting the base as far as possible, until it clicks and not turning it back to the original position 14 (9.3%) 15 (9.7%)
 Spiromax: Does not close the inhaler after taking the second dose  Turbuhaler: Does not place the cap back on the inhaler after taking the second dose 1 (0.7%) 7 (4.5%)
 Does not know how to read out the dose counter after asking the patient to check the number of doses left 0 4 (2.6%)
  1. BF budesonide formoterol, HCP healthcare professional, N/A not applicable
  2. aCohen’s Kappa Coefficient (measure the inter-rater (HCP and external) agreement of error) = − 0.606