A study to investigate the prevalence of device specific errors in inhaler technique in adults with airway disease (The SCORES Study): protocol for a single visit prevalence study

Background: It is a recurring theme in clinical practice that patients using inhaled medications via an inhaler do not use their device to a standard that allows for optimum therapeutic effect; with some studies showing that up to 90% of people do not use their inhalers properly. Observation and correction of inhaler technique by healthcare professionals is advised in both national and
international guidelines and should be performed at every opportunity to ensure that the optimum inhaler technique is being achieved by the user. This study will deliver greater understanding of which technique errors are made most frequently by people using 13 different inhaler types.

Objective: This study aims to identify and compare inhaler technique errors and their prevalence in adults, using device-specific checklists using manufacturers’ guidelines, for 13 specific inhaler types across all lung conditions and to correlate these errors with possible determinants of poor technique.
It also aims to assess the error frequency at each step in the device-specific questionnaires and compare error rates between device types.

Methods: In a single visit, participants using an inhaler included in the inclusion criteria will have their inhaler technique observed using an identical placebo device, recorded using device-specific checklists and optimised, or switched to a suitable inhaler.

Results: The study is already underway, and it is anticipated that the results will be available by 2021.

Conclusions: The SCORES Study will ascertain the prevalence of device-specific inhaler technique errors at each step in the device-specific checklists, compare error rates between 13 device types and correlate these errors with possible determinants of poor technique. Future work will involve the clarification and classification of these errors into ‘critical’ and ‘non-critical’ categories.