Assessment of inhalation technique in patients with bronchial asthma and chronic obstructive pulmonary disease

Abstract

Purpose: to evaluate inhalation techniques and their effect on the course of obstructive lung diseases. Materials and Methods: This cross-sectional study included 110 patients with asthma and chronic obstructive pulmonary disease (COPD) using different inhaler for at least one month. Inhaler errors performed during demonstration were evaluated for each patient and entered in the check-lists. We also collected information about co-morbidities, education, mMRC dyspnea score, rate of exacerbations, and spirometry. Results: 80.9% of patients used metered-dose inhaler (MDI), 20.9% - single-dose and 21.8% - multiple-dose dry powder inhaler (sDPI and mDPI), 22.7% - soft-mist inhaler (SMI). 76.7 % of patients were previously instructed about inhalation technique. Inhaler errors were observed in 80.9% patients. The mean number of errors for 1 patients with MDI use was 2±1.6, sDPI –1.5±1.3, mDPI- 1.25±1,4. SMI– 0.68±0,7 (р=0.003). Age, diagnosis, duration of disease, education level, inhalers usage by relatives had no influence on the inhalation technique. A number of errors was related to female gender (р=0.007), presence of neurological diseases (р=0.04), and usage of more than 1 inhaler (r=0.3, p=0.002), previous instruction about inhalation technique (r=0.3, p=0.001). On the other hand, there were correlations between the number of errors and degree of bronchial obstruction (r=-0.25), asthma control (r=-0.26), severity of dyspnea by mMRC score, exacerbation rate (r=0.63). Conclusions: Patients with obstructive lung diseases demonstrated numerous inhaler errors, that substantially impacted the severity and course of asthma and COPD.