open access

Vol 87, No 4 (2019)
ORIGINAL PAPERS
Published online: 2019-08-14
Submitted: 2019-04-16
Accepted: 2019-06-18
Get Citation

Inadequate inhaler technique, an everlasting problem, is associated with poor disease control – A cross sectional study

Manjulakshmi Padmanabhan, Kadhiravan Tamilarasu, Manju Rajaram, Gitanjali Batmanabane
DOI: 10.5603/ARM.2019.0036
·
Pubmed: 31476009
·
Adv Respir Med 2019;87(4):217-225.

open access

Vol 87, No 4 (2019)
ORIGINAL PAPERS
Published online: 2019-08-14
Submitted: 2019-04-16
Accepted: 2019-06-18

Abstract

Introduction: Dry powder inhalers (DPI) have been in use in the treatment of chronic respiratory diseases for decades. DPIs require proper inhaler technique to ensure appropriate dose delivery to the lungs which in turn provides disease control and hence reduces the economic burden due to frequent acute attacks and hospital visits. Inadequate inhaler technique remains an everlasting problem among patients with chronic respiratory disease. Hence the aim is to assess the inhaler technique in patients using DPI and to determine the factors associated with inhaler technique.
Material and methods: A cross-sectional study was conducted and 385 patients with asthma or chronic obstructive pulmonary disease (COPD) were recruited. Patient-related and disease-related factors were noted. Severity of the disease were assessed using asthma control test/COPD assessment test questionnaire and spirometer. The investigator assessed the inhaler technique of the patient against standard checklist.
Results: Nearly 46.2% of the patients performed incorrect inhaler technique. Multivariate analysis showed factors like young age [Odd’s ratio (OR) 4.13, CI 1.31–17.8], well controlled disease (OR 2, CI 1.1–3.65), and the patients who learnt the technique from a medical personnel (OR 3.67, CI 1.46–9.24) had better inhaler technique.
Conclusion: This study shows that the proper use of inhaler is still an unattained goal and significance of correct use has to be
reiterated.

Abstract

Introduction: Dry powder inhalers (DPI) have been in use in the treatment of chronic respiratory diseases for decades. DPIs require proper inhaler technique to ensure appropriate dose delivery to the lungs which in turn provides disease control and hence reduces the economic burden due to frequent acute attacks and hospital visits. Inadequate inhaler technique remains an everlasting problem among patients with chronic respiratory disease. Hence the aim is to assess the inhaler technique in patients using DPI and to determine the factors associated with inhaler technique.
Material and methods: A cross-sectional study was conducted and 385 patients with asthma or chronic obstructive pulmonary disease (COPD) were recruited. Patient-related and disease-related factors were noted. Severity of the disease were assessed using asthma control test/COPD assessment test questionnaire and spirometer. The investigator assessed the inhaler technique of the patient against standard checklist.
Results: Nearly 46.2% of the patients performed incorrect inhaler technique. Multivariate analysis showed factors like young age [Odd’s ratio (OR) 4.13, CI 1.31–17.8], well controlled disease (OR 2, CI 1.1–3.65), and the patients who learnt the technique from a medical personnel (OR 3.67, CI 1.46–9.24) had better inhaler technique.
Conclusion: This study shows that the proper use of inhaler is still an unattained goal and significance of correct use has to be
reiterated.

Get Citation

Keywords

adults, asthma, chronic obstructive pulmonary disease, dry powder inhaler, spirometry

About this article
Title

Inadequate inhaler technique, an everlasting problem, is associated with poor disease control – A cross sectional study

Journal

Advances in Respiratory Medicine

Issue

Vol 87, No 4 (2019)

Pages

217-225

Published online

2019-08-14

DOI

10.5603/ARM.2019.0036

Pubmed

31476009

Bibliographic record

Adv Respir Med 2019;87(4):217-225.

Keywords

adults
asthma
chronic obstructive pulmonary disease
dry powder inhaler
spirometry

Authors

Manjulakshmi Padmanabhan
Kadhiravan Tamilarasu
Manju Rajaram
Gitanjali Batmanabane

References (30)
  1. Global Initiative for Asthma (2018). Global Strategy for Asthma Management and Prevention [online] Available at: https://ginasthma.org/wp-content/uploads/2018/04/ wms-GINA-2018-report-V1.3-002.pdf [Accessed 10 Jun. 2018].
  2. Global Initiative for Chronic Obstructive Lung Disease (2018). Pocket guide to COPD diagnosis, Management and Prevention [online] Available from: https://goldcopd.org/wp-content/uploads/2018/02/WMS-GOLD-2018-Feb-Final-to-print-v2.pdf [Accessed 15 Jun. 2018].
  3. McKay AJ, Mahesh PA, Fordham JZ, et al. Prevalence of COPD in India: a systematic review. Prim Care Respir J. 2012; 21(3): 313–321.
  4. Yayan J, Rasche K. Asthma and COPD: similarities and differences in the pathophysiology, diagnosis and therapy. Adv Exp Med Biol. 2016; 910: 31–38.
  5. Broeders ME, Sanchis J, Levy ML, et al. ADMIT Working Group. The ADMIT series–issues in inhalation therapy. 2. Improving technique and clinical effectiveness. Prim Care Respir J. 2009; 18(2): 76–82.
  6. Levy ML, Dekhuijzen PNR, Barnes PJ, et al. Inhaler technique: facts and fantasies. A view from the Aerosol Drug Management Improvement Team (ADMIT). NPJ Prim Care Respir Med. 2016; 26: 16017.
  7. Sanchis J, Gich I, Pedersen S. Systematic review of errors in inhaler use. Chest. 2016; 150(2): 394–406.
  8. Sodhi M. Incorrect inhaler techniques in Western India: still a common problem. Int J Res Med Sci. 2017; 5(8): 3461.
  9. Chogtu B, Holla S, Magazine R, et al. Evaluation of relationship of inhaler technique with asthma control and quality of life. Indian J Pharmacol. 2017; 49(1): 110–115.
  10. Rootmensen GN, van Keimpema ARJ, Jansen HM, et al. Predictors of incorrect inhalation technique in patients with asthma or COPD: a study using a validated videotaped scoring method. J Aerosol Med Pulm Drug Deliv. 2010; 23(5): 323–328.
  11. Al-Jahdali H, Ahmed A, Al-Harbi A, et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Allergy Asthma Clin Immunol. 2013; 9(1): 8.
  12. Sharma R. Revision of Prasad's social classification and provision of an online tool for real-time updating. South Asian J Cancer. 2013; 2(3): 157.
  13. Sharma R. Online interactive calculator for real-time update of the Prasad’s Social Classification [Last accessed on 12 Jul. 2018] Available from: http://www.prasadscaleupdate.weebly.com .
  14. Fu JJ, McDonald VM, Gibson PG, et al. Asthma in older adults. Lancet. 2010; 376(9743): 803–813.
  15. Manríquez P, Acuña AM, Muñoz L, et al. Study of inhaler technique in asthma patients: differences between pediatric and adult patients. J Bras Pneumol. 2015; 41(5): 405–409.
  16. Kondo T, Hibino M, Tanigaki T, et al. Exhalation immediately before inhalation optimizes dry powder inhaler use. J Asthma. 2015; 52(9): 935–939.
  17. Sanchis J, Gich I, Pedersen S, et al. Aerosol Drug Management Improvement Team (ADMIT). Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016; 150(2): 394–406.
  18. Westerik JAM, Carter V, Chrystyn H, et al. Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting. J Asthma. 2016; 53(3): 321–329.
  19. Price DB, Román-Rodríguez M, McQueen RB, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract. 2017; 5(4): 1071–1081.e9.
  20. Visser R, Wind M, de Graaf BJ, et al. The effect of body posture during medication inhalation on exercise induced bronchoconstriction in asthmatic children. Respir Med. 2015; 109(10): 1257–1261.
  21. Braido F, Chrystyn H, Baiardini I, et al. Respiratory Effectiveness Group. Trying, but failing — the role of inhaler technique and mode of delivery in respiratory medication adherence. J Allergy Clin Immunol Pract. 2016; 4(5): 823–832.
  22. Rachelefsky GS, Liao Y, Faruqi R. Impact of inhaled corticosteroid-induced oropharyngeal adverse events: results from a meta-analysis. Ann Allergy Asthma Immunol. 2007; 98(3): 225–238.
  23. Samec T, Amaechi BT, Battelino T, et al. Influence of anti-asthmatic medications on dental caries in children in Slovenia. Int J Paediatr Dent. 2013; 23(3): 188–196.
  24. Melzer AC, Ghassemieh BJ, Gillespie SE, et al. Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD. Respir Med. 2017; 123: 124–130.
  25. Press VG, Arora VM, Trela KC, et al. Effectiveness of interventions to teach metered-dose and diskus inhaler techniques. A randomized trial. Ann Am Thorac Soc. 2016; 13(6): 816–824.
  26. Aydemir Y. Assessment of the factors affecting the failure to use inhaler devices before and after training. Respir Med. 2015; 109(4): 451–458.
  27. Souza ML, Meneghini AC, Ferraz E, et al. Knowledge of and technique for using inhalation devices among asthma patients and COPD patients. J Bras Pneumol. 2009; 35(9): 824–831.
  28. Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008; 102(4): 593–604.
  29. Giraud V, Allaert FA, Roche N. Inhaler technique and asthma: feasability and acceptability of training by pharmacists. Respir Med. 2011; 105(12): 1815–1822.
  30. Chorão P, Pereira AM, Fonseca JA. Inhaler devices in asthma and COPD--an assessment of inhaler technique and patient preferences. Respir Med. 2014; 108(7): 968–975.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl