TABLE 1

List of critical errors used for the scoring of inhalation technique#

DiskusAutohaler
Preparation
 1Device is not opened correctly until a “click” is heardInhaler cap is not removed before use
 2Device is not held horizontally with counter facing up while preparing (45° tolerance)Inhaler is not held upright with lever on top (45° tolerance)
 3Lever is not pushed back until another “click” is heardLever is not pushed up before inhalation
Inhalation
 4Exhales into the deviceAfter fully exhaling, teeth and lips are not sealed around mouthpiece
 5Mouthpiece is not correctly sealed between teeth and lipsInhalation stops directly after firing the inhaler
 6Insufficiently deep inhalationInsufficiently deep inhalation
 7No breath-hold for ≥10 sNo breath-hold for ≥10 s

#: partly adopted from the standardised inhalation protocols distributed by the Lung Alliance Netherlands [9].