Real-world observational study of the evaluation of inhaler techniques in asthma patients

Chaicharn Pothirat, Warawut Chaiwong, Atikun Limsukon, Nittaya Phetsuk, Nonglak Chetsadaphan, Woranoot Choomuang, Chalerm Liwsrisakun

Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

Abstract

Background: Inhaler devices are a keystone in the management of asthma during the maintenance phase of treatment.
Objective: To evaluate techniques for using inhaler devices in asthma patients.
Methods: A prospective cross-sectional study was conducted to assess patient compliance with correct techniques for using inhaler devices across three regimens: pressurized metered-dose inhaler (pMDI), Accuhaler®, and Turbuhaler®. The compliance of patients with essential steps for correct device usage in the case of each regimen was recorded. These were recorded when patients presented for a routine visit and one month after receiving face-to-face training. The percentage of compliance between the use of the devices and the risk factors related to incorrect techniques were analyzed by logistic regression analysis. The percentages of incorrect techniques were compared between the two visits using a Chi-squared test.
Results: A total of 108 asthma patients (35.2% male), with a mean age of 57.5 ± 12.3 years were evaluated. Percentages of incorrect use of Accuhaler®, pMDI, and Turbuhaler® were 50%, 48%, and 55.6%, respectively. The most common incorrectness’s is breath out gently to residual volume (approximately one-third). Previous treatment by a pulmonologist for less than 2 years was the single factor related to incorrect technique [Adjusted OR = 2.8 (95%CI, 1.2-6.3), p = 0.02]. Formal training resulted in a statistically significant decrease in percentage of incorrect techniques (52.8% vs. 32.1%, p = 0.02).
Conclusion: Inhalation technique in asthma patients was mostly unsatisfactory, especially in patients who had been treated by a pulmonologist for less than 2 years. Face-to-face training significantly improved good technique in all devices.
Key words: asthma, inhalation, technique, device, medication