{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:58:51Z","timestamp":1790416731872,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":268,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["001"],"award-info":[{"award-number":["001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Canadian Respiratory Journal"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The correct use of inhalation devices is essential for achieving adequate control of asthma and COPD; however, critical errors in inhalation technique are frequent and substantially reduce treatment effectiveness. This study\u2019s objective was to evaluate the prevalence of inadequate inhalation technique among patients with asthma and COPD and to identify the most common critical errors and the factors associated with incorrect use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional observational study included 575 patients (aged \u2265\u200918\u2009years) with asthma and\/or COPD, recruited from a university hospital outpatient pulmonology clinic and a public specialized pharmacy (Natal, Brazil). Participants completed sociodemographic questionnaires and demonstrated their inhaler technique, which was assessed using device\u2010specific checklists to identify critical errors. Factors associated with critical errors were analyzed using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Only 8.2% of participants correctly performed all steps of the inhalation technique. At least one critical error was observed in 73.4% of the cohort. In multivariable analysis, advanced age (OR: 1.029; 95% CI: 1.016\u20131.044), use of multiple devices (OR: 2.500; 95% CI: 1.754\u20133.562), and type of mechanism independent of inspiration (OR: 0.262; 95% CI: 0.160\u20130.430; protective factor) were significantly associated with critical errors (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inadequate inhalation technique, particularly the occurrence of critical errors, was highly prevalent, especially among older patients and those using multiple devices. Inhalers dependent on inspiratory effort demonstrated greater vulnerability to incorrect use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/carj\/8222875","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:16:12Z","timestamp":1790414172000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Critical Errors in Inhaler Technique Among Patients With Asthma and COPD: A Cross\u2010Sectional Study in a Real\u2010World Setting"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-2526-9029","authenticated-orcid":false,"given":"Italo Henrique Medeiros","family":"Damasceno","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5229-8177","authenticated-orcid":false,"given":"Ricardo Jos\u00e9 Fonseca De","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9651-0600","authenticated-orcid":false,"given":"Sabrina Joany Felizardo","family":"Neves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9668-0482","authenticated-orcid":false,"given":"Rand Randall","family":"Martins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2634-0447","authenticated-orcid":false,"given":"Rodrigo Dos Santos","family":"Diniz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1066804"},{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/bs.apha.2023.03.001"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2022.106949"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2023-002211"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41533-018-0110-x"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41533-017-0016-z"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-017-0710-y"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-023-02566-6"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.2147\/TCRM.S160365"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-020-01246-z"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198601000-00007"},{"key":"e_1_2_10_12_2","unstructured":"Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention 2021 2022 https:\/\/ginasthma.org\/gina-reports\/."},{"key":"e_1_2_10_13_2","unstructured":"Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) Global Strategy for the Diagnosis Management and Prevention of Chronic Obstructive Pulmonary Disease 2021 2022 https:\/\/goldcopd.org\/gold-reports\/."},{"key":"e_1_2_10_14_2","first-page":"S1","article-title":"Diretrizes Da Sociedade Brasileira De Pneumologia E Tisiologia Para O Manejo Da Asma","volume":"38","author":"Sociedade Brasileira De Pneumologia E Tisiologia","year":"2012","journal-title":"Jornal Brasileiro De Pneumologia"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.05.00009605"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pulmoe.2020.04.010"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1862"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2023-001964"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/8755122520937649"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2023.04.031"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2023.107430"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1089\/jamp.2019.1556"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.10569"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.21271\/ZJPAS.35.6.13"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.4328\/ACAM.20354"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41533-021-00218-y"},{"key":"e_1_2_10_27_2","doi-asserted-by":"publisher","DOI":"10.4103\/picr.PICR_210_19"},{"key":"e_1_2_10_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2022.106849"},{"key":"e_1_2_10_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21605"},{"key":"e_1_2_10_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/jphsr\/rmad032"},{"key":"e_1_2_10_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2021.e07870"},{"key":"e_1_2_10_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1656"},{"key":"e_1_2_10_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2021.106507"}],"container-title":["Canadian Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/carj\/8222875","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/carj\/8222875","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/carj\/8222875","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:16:14Z","timestamp":1790414174000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/carj\/8222875"}},"subtitle":[],"editor":[{"given":"Ming","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/carj\/8222875"],"URL":"https:\/\/doi.org\/10.1155\/carj\/8222875","archive":["Portico"],"relation":{},"ISSN":["1198-2241","1916-7245"],"issn-type":[{"value":"1198-2241","type":"print"},{"value":"1916-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-04-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"8222875"}}