Metered-dose Inhaler Technique Research Articles

Evaluation of the Metered Dose Inhaler Technique: Initial Assessment and Post-counseling Improvements Among the Indian Population.

Objective The objective of this study was to evaluate errors in the use of metered-dose inhalers (MDIs) among patients diagnosed with asthma or chronic obstructive pulmonary disease (COPD). Additionally, we aimed to assess improvements following corrective interventions. Settings and design This cross-sectional study was done by simple random sampling. Methods and materials This study was done at a tertiary care center in South India in an outpatient department and ward for tuberculosis and chest disease to find out the right way to use an MDI and investigate the reasons why people with asthma and COPD don't use it correctly. There were a total of 12 steps. The patient was given an empty canister to try the inhalation technique and was scored one pointfor every correct step and zero for every incorrect step, for a total of 12 steps.Following the demonstration, an educator used a variety of tools, including verbal communication, pictorial demonstrations,and practical demonstrations, to correct the mistakes. After education was provided, post-interventional data was collected. Results During pre-intervention of the 12 steps out of the 183 participants, step one had 183 correct participants (100%), step two had 104 correct participants (56.83%), step three had 129 correct participants (70.49%), step four had 71 correct participants (38.79%), step five had 167 correct participants (91.25%), step six had 123 correct participants (67.21%), step seven had 132 correct participants (72.13%), step eight had 81 correct participants (43.71%), step nine had 123 correct participants (67.21%), step 10 had 108 correct participants (59.01%), step 11 had 128 correct participants (69.94%), and step 12 had 175 correct participants (95.62%). During the post-intervention of the 12 steps, out of the 183 participants, step one remained at 183 correct participants (100%), step two increased to 149 correct participants (81.42%), step three to step seven increased to 183 correct participants (100%), step eight increased to 142 correct participants (77.59%), step nineincreased to 174 correct participants (95.08%), step 10 increased to 177 correct participants (96.72%), step 11 increased to 143 correct participants (78.14%) and step 12 increased to 177 correct participants (96.72%). Conclusion This study highlights the prevalent errors in the use of metered-dose inhalers (MDIs) among patients diagnosed with asthma or chronic obstructive pulmonary disease (COPD). The results demonstrate significant improvements in the MDI technique. Following educational interventions such as verbal communication, pictorial demonstrations,and practical exercises, patients were able to correct their inhaler technique effectively and emphasized the importance of patient education and counseling to ensure the maintenance of correct usage over time.

Competence of pediatric residents and nurses in metered-dose inhaler techniques for asthma patients at Tikur Anbessa Specialized Hospital

Introduction: A Metered Dose Inhaler (MDI) is a device containing dissolved or suspended drugs to deliver drugs for pulmonary diseases efficiently. However, studies in Ethiopia show low competency among health professionals. Thus, we assessed the competency of residents and nurses working in a tertiary hospital. 
 Methods: From June to September 2022, 181 pediatrics and child health department residents and nurses participated in a pretested questionnaire and MDI technique practice. The knowledge score for residents and nurses was determined based on correct answers to questions from 0 to 6 for residents and 0 to 5 for nurses. Good knowledge was defined as a score of 80–100%, moderate knowledge from 60–79%, and poor knowledge from <60% of the total score. The good practice was ≥7 from 11 and all essential steps, while the poor practice was <7 of the total score and skipped essential steps. The chi-square or Fisher exact test was employed to compare groups as appropriate. The 95% confidence interval and a p-value of 0.05 were used to determine statistical significance. . 
 Results: Of the 181 study participants, 103 (56.9%) were residents. The participants' mean age was 32. MDI technique knowledge was poor for more than half of the residents (52.4%) and 46.4% of the nurses. Twenty-six (14.4%) of participants practiced the MDI technique steps, scoring 7 out of 11 steps. However, only 3.3% practiced the technique correctly. Whereas only 5.8% of residents and 0% of nurses practiced the essential steps of the MDI technique. When using a new inhaler drug, nearly half of the participants (47%) did not assess the patients' practice. 
 Conclusion: Healthcare professionals' competency in performing the MDI technique is low. Appropriate training programs are needed to enhance their ability to use inhaled devices and ensure successful drug delivery.

Practice of Metered Dose Inhaler Technique and Health Impacts of COPD Patients in Bangladesh

Objective: This study aimed to identify the practice of the Metered Dose Inhaler (MDI) technique and the health impact of disease and investigate their relationship among COPD patients in Bangladesh. Methods: This was a descriptive correlational study. 102 COPD patients were recruited conveniently from Dhaka's National Institute of Diseases of the Chest and Hospital (NIDCH). The data was collected from September to October 2023. Data was collected using an observation checklist and a face-to-face interview using a structured questionnaire. A 12-point checklist was used to assess the practice of the MDI technique, and the COPD Assessment Test (CAT) questionnaire was used to measure the health impact. Both descriptive and inferential statistics were used to analyze data. Result: Only 5.9% of COPD patients correctly performed the MDI using the technique, and more than half of the patients had a high health impact on COPD. A significant relationship was found between the practice of the MDI technique and the health impact of COPD patients (p=0.001)). The practice of the MDI technique was also associated with the patient's age, smoking, employment status and duration of using MDI. In contrast, the health impact of COPD was associated with the patient's age, education status, marital status, smoking, employment status, monthly family income and duration of using MDI. Conclusion: It is concluded that the majority of COPD patients incorrectly practice their MDI technique, and the health impact on COPD is high. Inhaler teaching and training are highly recommended for COPD patients to minimize errors and promote correct inhaler techniques.

Effectiveness of one-to-one feedback methods of teaching with proper metered-dose inhaler technique and correcting errors in chronic obstructive lung disease patients

Abstract Objective To determine the most common mistakes made during the use of a metered-dose inhaler (MDI), and the effect of the repeated trainings performed with demonstration method by providing one-to-one feedback on these mistakes. Methods This is a quasi-experimental study with a control group. A total of 100 chronic obstructive pulmonary disease (COPD) patients (50 in the control group and 50 in the experimental group) were included in the research. “Patient Information Form (PIF)” (to determine the descriptive characteristics of patients) through the face-to-face interview method, using “MDI Skill Assessment Form” (MDISAF) (it is composed of 10 skill steps about the use of MDI) through observation method was used. Patients in both the groups were asked to use MDI and their abilities regarding use of MDI were assessed. Then in the intervention group, usage of MDI was explained by a nurse via demonstration and placebo MDI. Trainings were repeated on days 1,3, and 5 as from hospitalization of the patient. In the intervention group, three methods were used in this study: “face-to-face training,” “one-to-one,” and “with feedbacks and repeated.” Routine training regarding use of MDI was given by the nurses in the clinic to patients in the control group. The use of an MDI was assessed using MDISAF before training and after the training on the first, third and fifth days of hospitalization. On the seventh day, the last measurement was performed. Percentage, chi square, and mean were used to assess the data. Results After repetitive training with one-to-one feedback, several differences between the groups in favor of the experimental group were found in 7 of the 10 skill levels of the MDI. There was a significant difference after “training” between the groups in the third, fourth, fifth, sixth, seventh, eighth and ninth MDI steps in posttest measurement (P < 0.05). Evaluating the skills of the groups to use MDI from pretest to posttest, it was determined that while the intervention group made less mistakes in steps in which mistakes were made mostly, the control group continued to make mistakes. Conclusions Inhaler technique intervention with repeated, face to face, and one-to-one feedback trainings can significantly enhance the MDI techniques in COPD patients. The patients in the intervention group made less mistakes during MDI application and their application skills improved. It may be asserted that the training provided to the intervention group was effective for using the device correctly, while the training provided in the clinic for the control group was inadequate.

Metered-dose Inhalers: Assessing Educational Gaps in Internal Medicine Residency, and Improving Training on Proper Technique

Although internists provide outpatient asthma care, there are recognized gaps in internal medicine resident education on proper metered-dose inhaler (MDI) technique and on patient technique assessment. This study aimed to identify these gaps and to provide teaching interventions.

Impact of an education program on knowledge, metered-dose inhaler technique among asthma patients in a tertiary care hospital

Background: Inhalers are most often prescribed to asthma patients and patients need to inhale correctly and coordinate breathing and actuation to ensure effective drug delivery. Important reasons for uncontrolled asthma include poor adherence, poor asthma knowledge by patients, and poor skills in inhaler technique. Aims and Objectives: The aims and objectives were to evaluate the impact of education program on knowledge and metered-dose inhaler (MDI) technique among asthma patients. Materials and Methods: This study was conducted among asthma patients using a pre- and post-education intervention on inpatients getting admitted under the Department of Pulmonary Medicine attached to Victoria Hospital, BMCRI. The pre- and post-test involved the administration of a questionnaire on asthma knowledge, demonstration of steps of the inhaler technique using a standard checklist. Results: The total mean percentage score of asthma knowledge was 45.45% pre-intervention which increased significantly to 88.63% after education intervention (P < 0.0001). The pMDI (pressurized MDI) demonstration improved from 25% (pre-intervention) to 62% post-intervention (P < 0.0001). Conclusion: Educating about the disease and regular periodic assessment of inhaler technique to asthma medications will improve asthma outcome.

The Impact of Theoretical and Practical Guidance Regarding Metered Dose Inhaler Technique on Asthma Patients

Published on:August 2022Journal of Young Pharmacists, 2022; 14(3):327-332Original Article | doi:10.5530/jyp.2022.14.64 Authors: Sara Shahid1,2,*, Fahad Ahmed3, Gul Shahnaz1, Muhammad Saqlain1, Muhammad Ans4, Anosh Sana1, Abdul Nazer Ali5, Ahmad Kamal Ariffin Abdul Jamil6, Asma Fareed Khan7,8, Saba Naeem9, Shakeel Ahmad9, Aiman Mahmood4,9, Qandeel Rafi9, Asifa Anwar2, Rabeel Khan2, Naeem Mubarak2 1Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, PAKISTAN. 2Department of Pharmacy Practice, Lahore Pharmacy College, Lahore Medical and Dental College, University of Health Sciences, Lahore, PAKISTAN.3Faculty of Pharmacy, University of Sargodha, Sargodha, PAKISTAN.4University College of Pharmacy, University of the Punjab, Lahore, PAKISTAN.5Department of Pharmacy Practice, Geethanjali College of Pharmacy, Hyderabad, Telangana, INDIA.6Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, UniSZA, Besut, Terengganu, MALAYSIA.7Disciplines of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, MALAYSIA. 8Children’s Hospital & University of Child Health Sciences, Lahore, PAKISTAN. 9Department of Pharmaceutics, Lahore Pharmacy College, Lahore Medical and Dental College, University of Health Sciences, Lahore, PAKISTAN. Abstract: Background: Asthma is rapidly increasing globally. Inhalation therapy is the backbone for asthma management due to localized delivery and rapid onset of action. Currently, metered dose inhalers (MDIs) are the most widely prescribed and dispensed inhaler devices worldwide due to the advantage of portability, multiple dose delivery and better efficacy. Objectives: The current study aimed to access the effect of educational intervention on asthma patients’ competency regarding pressurized metered dose inhaler (pMDI) technique. Methods: Asthma patients were recruited from Pakistan Institute of Medical Sciences (PIMS) Islamabad, Pakistan. Inhaler technique steps based upon “National Asthma Education and Preventive Program” (NAEPP) criteria was set as evaluating tool to evaluate competency of asthma patients regarding MDI appropriate technique. Intervention involved educating study subjects (asthma patients) practically through placebo inhaler and theoretically through inhaler technique directed literature brochures. Pre intervention and post intervention inhaler technique competency was accessed and evaluated statistically. Results: Among 207 asthma patients, majority were never instructed by healthcare professional regarding inhaler technique (78.8%). However, most of the patients were observed to have inadequate inhaler technique (76.3%) at baseline. As the result of educational intervention, the competency of patients regarding inhaler technique was significantly enhanced from 11.6% pre-intervention to 34.8% post-intervention (p<0.001), statistically analyzed by McNemar testing. Conclusion: Originally, inhaler technique competency of majority of asthma patients was observed to be inappropriate. However, educational intervention proved to be effective in substantially enhancing the competency of study subjects regarding MDI technique. Keywords: Asthma, Inhalation therapy, Metered-dose inhalers, Educational intervention, National Asthma Education and Preventive Program.

The Impact of an Educational Intervention on the Skill of Community Pharmacists in the Use of a Pressurized Metered-dose Inhaler: A Covert Simulated Patient Approach in Pakistan

Introduction: Metered-dose inhalers are the most widely prescribed and dispensed inhaler devices worldwide for the management of asthma. The present study aimed to access the impact of educational intervention on the competency of community pharmacists of Islamabad, Pakistan regarding the pressurized metered-dose inhaler (MDI) technique. Materials and Methods: The intervention involved educating pharmacists practically through placebo inhalers and theoretically through literature brochures; based upon the “National Asthma Education and Preventive Program” inhaler technique. A total of 100 pharmacists were recruited from the rural and urban sectors of Islamabad. A covert simulated patient approach was used to evaluate the inhaler technique of pharmacists. Type of pharmacy, education status of pharmacists and the influence of already received training on the use of inhaler devices were the factors that demonstrated a significant positive association with the competency of pharmacists. Results: McNemar test was applied for pre and post-intervention intragroup comparisons to further access categorical variables. A p-values &lt;0.05 were considered statistically significant. The competency of pharmacists increased significantly from 24% before intervention to 33% after intervention (p&lt;0.001). Conclusion: Originally, the inhaler technique competency of the majority of pharmacy professionals was observed to be inappropriate. However, the educational intervention proved to be effective in substantially enhancing the skill of community pharmacists regarding the MDI technique.

Health literacy and type of education intervention predicting post-education metered-dose inhaler misuse

BackgroundAsthma and chronic obstructive pulmonary disease (COPD) guidelines recommend self-management assessment and inhaler education at all care-visits. Assessment is vital for identifying inhaler misuse. Whether age-related factors impede the efficacy of educational interventions for inhaler technique among older patients is unknown. We aimed to study factors associated with metered-dose inhaler (MDI) misuse pre/post-inhaler education among younger (< 65) and older inpatient populations (≥ 65). MethodsAdult inpatients with asthma or COPD enrolled across five studies between 2007 and 2017, who were eligible for, consented, and assigned to one of three education interventions (Brief Intervention [BI], Teach-to-Goal [TTG], Virtual Teach-to-Goal [V-TTG]) were included. Participants' visual acuity, health literacy, and MDI technique pre/post education were assessed using validated assessments. Binary logistic regression was used to investigate factors that increased odds of inhaler misuse. ResultsAcross the five studies, 394 unique participants were enrolled with a mean age of 51.9 years (SD±15). There was no significant difference in baseline MDI misuse by age, vision, or health literacy levels. Post-education misuse use was lower among patients with better baseline MDI technique, those who received TTG or V-TTG education, and those with high health literacy. Neither age nor visual acuity were significantly associated with increased rates of misuse, although age was correlated with low health literacy. ConclusionMDI education with teach-to-goal modalities is more effective than brief intervention; however, patients with low health literacy (disproportionately affecting older patients) may benefit less from these interventions. Further investigation into tailored inhaler education is needed.

Pharmacist‐led inhaler training for nurses on an acute care pulmonary unit

AbstractIntroductionAppropriate inhaler technique is important for optimizing treatment of pulmonary conditions, including asthma and chronic obstructive pulmonary disease. Nurses often administer inhaled medications in the acute care setting, providing an opportunity to educate patients on appropriate inhaler technique. To date, no published study has evaluated the impact of pharmacist‐led training on skill improvement and retention among acute care pulmonary nursing staff regarding their ability to instruct a patient on inhaler technique.ObjectiveThe primary objective of this study was to evaluate both the immediate and sustained impact of pharmacist‐led inhaler technique for acute care pulmonary nurses using hands‐on training for instructing on appropriate inhaler use.MethodsThis prospective study used a one group pre‐test, posttest design for an educational intervention. Pharmacists conducted a brief in‐service followed by an individualized simulation where the nurse participant instructed a standardized patient on how to use a placebo metered dose inhaler (MDI) and dry powder inhaler (DPI) before and after receiving individual technique training by a pharmacist. Participant inhaler counseling technique was assessed via standardized checklist. Nurses then received individual coaching from a pharmacist regarding proper inhaler technique. After the pharmacist intervention, the nurse again counseled the standardized patient on how to use the devices. Measures included investigator rating on inhaler technique at baseline, after training, and 2 months later.ResultsAfter the interventions, participant performance significantly improved for MDI and DPI technique. At the 2‐month follow‐up, there was a statistically significant increase for MDI and DPI technique from baseline.ConclusionBrief, pharmacist‐led inhaler technique education results in sustained improvements in inhaler administration skills among pulmonary nursing staff.

Effectiveness of the BreatheSuite Device in Assessing the Technique of Metered-Dose Inhalers: Validation Study.

The majority of medications used in treating asthma and chronic obstructive pulmonary disease (COPD) are taken through metered-dose inhalers (MDIs). Studies have reported that most patients demonstrate poor inhaler technique, which has resulted in poor disease control. Digital Health applications have the potential to improve the technique and adherence of inhaled medications. This study aimed to validate the effectiveness of the BreatheSuite MDI device in assessing the technique of taking a dose via an MDI. The study was a validation study. Thirty participants who self-reported a diagnosis of asthma or COPD were recruited from community pharmacies in Newfoundland and Labrador, Canada. Participants used a BreatheSuite MDI device attached to a placebo MDI and resembled taking 3 doses. Pharmacists used a scoring sheet to evaluate the technique of using the MDI. An independent researcher compared the results of the pharmacist's scoring sheet with the results of the BreatheSuite device. This study found that the BreatheSuite MDI can objectively detect several errors in the MDI technique. The data recorded by the BreatheSuite MDI device showed that all participants performed at least one error in using the MDI. The BreatheSuite device captured approximately 40% (143/360) more errors compared to observation alone. The distribution of participants who performed errors in MDI steps as recorded by BreatheSuite compared to errors reported by observation alone were as follows: shaking before actuation, 33.3% (30/90) versus 25.5% (23/90); upright orientation of the inhaler during actuation, 66.7% (60/90) versus 18.87% (17/90); coordination (actuating after the start of inhalation), 76.6% (69/90) versus 35.5% (32/90); and duration of inspiration, 96.7% (87/90) versus 34.4% (31/90). The BreatheSuite MDI can objectively detect several errors in the MDI technique, which were missed by observation alone. It has the potential to enhance treatment outcomes among patients with chronic lung diseases.

Hands-on training on inhaled devices to boost pharmacy students’ performance during inhaler counselling

Objective: The effective use of inhalers depends on completeness of information from healthcare providers. As pharmacists acquire foundational skills on inhalers from their undergraduate curriculum, the experience and performance of pharmacy students regarding inhaler counselling should be explored. Methods: Pharmacy students who completed their final year of study answered an online questionnaire on their experience with teaching-learning activities on inhalers. Students also underwent an objective structured clinical exam that included Turbuhaler device counselling. Results: 84 students who completed the online questionnaire strongly agreed that the curriculum increased their awareness of different types of inhalers (65.5%) and specific techniques for use (64.3%). Students reported being able to counsel on metered-dose inhaler (98.8%) and dry-powder inhaler (92.8%) techniques. Students performed well (M=9.4, SD=2.7) at Turbuhaler counselling from a full score of 14. Conclusions: The current training on inhaler devices was useful for the pharmacy students. Future training should emphasise supplementary advice on inhaler taste and gargling.

Practice on Metered Dose Inhaler Techniques and Its Associated Factors among Asthmatic Patients at Debre Markos Comprehensive Specialized Hospital, East Gojjam, Ethiopia: A Prospective Study.

Background Asthma stands 16th among the leading causes of years lived with disability and 28th among the leading causes of disease in the world. A metered-dose inhaler remains the principal route for drug administration, and it has greater advantages over systemic treatment. In routine use, however, a majority of patients make inhalation errors. Suboptimal inhaler technique worsens health outcomes, with poor disease control, and increases the risk of hospitalization. This study aimed to assess practice metered-dose inhalation techniques and associated factors among asthmatic patients at Debre Markos Comprehensive Specialized Hospital, East Gojjam, Amhara region, Ethiopia. Methods Prospective cross-sectional study was conducted from July 15 to August 30, 2020. Data were collected through a semistructured questionnaire. The data were analyzed using SPSS version 25. Associations between dependent and independent variables were assessed by using binary and multiple logistic regressions. P values less than 0.05 were considered to be statistically significant in all cases. Results are presented in tables, figures, numbers, and percentages. Result A total of 166 patients had involved in the study, of which 52.4% were females. One hundred and eleven (66.9%) participants had good knowledge of asthma and inhalational techniques, while the rest of them had poor knowledge. One hundred and eight (65.1%) patients had effective practice on metered-dose inhaler use techniques. Participant's knowledge regarding asthma and meter dose inhaler and marital status has a significant association with their practice of metered-dose inhaler techniques with P value 0.001 and 0.006, respectively. Conclusion In this study, most participants are suffering from asthma for a long duration and they have repeated exacerbation. Around two-thirds of patients had good knowledge regarding asthma and metered-dose inhaler and practice on metered-dose inhaler techniques. Participants with poor knowledge had poor practice on metered-dose inhaler techniques, and single patients were less likely to have poor practice on metered-dose inhaler techniques. Health education and counseling services should be consistently provided to the clients regarding the proper steps of inhalers use.

Factors associated with improper metered-dose inhaler technique among adults with asthma in a primary care clinic in Malaysia.

Metered-dose inhalers (MDI) are the most used inhalers worldwide. However, improper MDI techniques remain a significant problem and cause uncontrolled asthma. Studies worldwide have reported that the causes of inefficient inhaler technique are multifactorial. However, this topic has been less well studied in the Asian population. This study aimed to evaluate the MDI technique and associated factors among adults with asthma in a primary care setting in Malaysia. This was a cross-sectional study with universal sampling conducted between July and October 2017. A total of 146 patients with asthma aged 18 years and older in a primary care clinic in Putrajaya, Malaysia were recruited. Logistic regressions were used for statistical analysis to examine the association between improper MDI techniques and their related factors. The majority (83%) of respondents were female with a median age of 37 (IQR = 30.75-49.25) years, and the median duration of asthma of 20 (IQR = 10-30) years. An improper MDI technique was observed in 100 (71.9%) patients. The most frequently missed step was exhaling gently and fully before inhalation (51.4%). Respondents who were not on an MDI preventer (adjusted OR: 2.487, 95% CI: 1.121-5.519, p = 0 .025) or had used an MDI 5 years or fewer (adjusted OR: 3.369, 95% CI: 1.425-7.964, p = 0.006) were more likely to employ an improper MDI technique. There was a high proportion of improper MDI techniques among patients with asthma. Patients not using an MDI preventer or who had used an MDI less than 5 years were at higher risk of improper MDI technique.

Competence in metered-dose inhaler technique among healthcare workers of three general hospitals in Mexico: it is not good after all these years.

Inhaled medication is the cornerstone of pharmacological treatment for chronic respiratory diseases. Therefore, it is important to use a metered-dose inhaler (MDI) correctly to get the appropriate dosage and benefit from the drug. Health-care workers (HCW) are responsible for teaching the correct MDI technique. Unfortunately, numerous studies consistently show that HCW have poor MDI technique. This study aimed to evaluate the current knowledge of MDI technique in HCW working in three general hospitals. A hospital-based, cross-sectional descriptive study was conducted in three general hospitals in Aguascalientes, México. Three surveyors simultaneously scored through a 14 dichotomic questions list as bad, regular, good, and very good MDI technique. Data were analyzed with SPSS version 16. Statistical analyses were performed using chi-square test or unpaired t-tests. An analysis of one-way ANOVA was used for comparison of three independent general hospitals. Values of p < 0.05 were considered to indicate statistical significance. A total of 244 HCWs were surveyed: 78.3% were nurses whereas 21.3% were physicians. The inter-observer concor-dance analysis among observers was 0.97. We observed that 32.4% (79) performed a bad technique, 51.6% (126) a regular technique, 13.5% (33) a good one, and 2.5% HCW (6) a very good technique. No difference between gender, labor category, schedule, service, age, seniority, and education degree between the three hospitals was observed. The most common mistakes were "insufficient expiration prior to activation of the device", and "the distance the inhaler was placed for inhalation" (83 and 84% respectively). We observed that a high percentage of HCW do not follow the MDI technique correctly, being this percentage even higher than the reported in other studies. These observations suggest the urgent need to establish frequent training programs for the correct use of MDI.

An evaluation of metered-dose inhaler administration technique among patients of asthma and chronic obstructive pulmonary disease in Saudi Arabia

Context Patients with asthma and chronic obstructive pulmonary disease (COPD) are majorly prescribed inhaled medications. This prescription is based on their efficacy and few adverse effects. Aim The study intends to evaluate metered-dose inhaler (MDI) administration technique among patients of asthma and COPD in Saudi Arabia. Settings and design A retrospective, cross-sectional observational design was used, and it was performed at the chest out-patient clinic at King Faisal Medical Complex, Taif, Saudi Arabia. Materials and methods A total of 144 Saudi patients who were diagnosed either for asthma and COPD were included. It also included patients with prescribed inhalation agents in the form of MDI. Statistical analysis IBM SPSS (Statistical Package for the Social Sciences) version 23.0. was used. Demographic characteristics were presented in the form of percentages and frequencies, whereas descriptive statistics were also applied. The significance value was determined at P value less than or equal to 0.05. Results Patients with asthma majorly used MDI technique, had unlimited attacks per month, and had experienced less than five attacks per month. The demographic evaluation showed that sex and age are insignificantly related to the use of MDI. However, education, medical diagnosis, number of asthmatic attacks per month, and duration of the MDI use were significantly related to the proper use of the MDI technique. Conclusion The findings of the study recommend that although patients were aware of the correct use, more training needs to be initiated. Educational intervention programs should be initiated for improving the MDI technique use among patients.

Uncontrolled asthma in Ethiopia: a systematic review and meta-analysis.

Despite significant improvement in the diagnosis and management of this disorder, asthma in the majority of Ethiopians remains poorly controlled. Although the prevalence of uncontrolled asthma is a public health problem in Ethiopia, its reported prevalence varies from study to study. Hence, this review aims to determine the true prevalence of uncontrolled asthma among asthmatic patients in Ethiopia. Different database searching engines were used including PubMed, Scopus, Google Scholar, Africa journal online, World Health Organization (WHO) afro library, and Cochrane review. They were systematically searched for published studies on uncontrolled asthma in Ethiopia from 2014 to 2019. Primary search terms were "asthma", "uncontrolled asthma", "uncontrolled wheezing", and "Ethiopia". The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. Publication bias was examined by the funnel plot. The random-effect model was fitted to estimate the pooled prevalence of uncontrolled asthma among asthmatic patients. All statistical analysis was done using R version 3.5.3 and the RStudio version 1.2.5033 software for Windows. The overall pooled prevalence of uncontrolled asthma was found to be 71.67% [95% CI (0.6772; 0.7562)]. Potential associated factors were: unscheduled visits, frequency of short-acting beta2-agonist (SABA) use, type of treatment and perceived rate of asthma control, low monthly income, age group, presence of comorbidity, moderate persistent asthma, severe persistent asthma and use of SABA alone as anti-asthmatic medication, use of biomass fuel for cooking, longer duration of asthma (> 30 years), incorrect inhalation technique, and asthma exacerbation in the last 12 months. Self-perceived poor asthma control was associated with any activity limitation due to asthma, inconsistent inhaled corticosteroid use, and lack of health education on metered-dose inhaler technique [AOR =4.96; 95% CI (1.08-22.89)]. Nearly two-thirds of patients were determined to have uncontrolled asthma. Thus, this evidence suggests that attention should be given to asthma patients and health care providers.

Use of patient assessment skills in advanced pharmacy practice experiences

IntroductionPharmacy programs are required to teach patient assessment (PA) skills. However, pharmacist workforce survey data indicates that limited opportunities exist for students to practice PA skills in real-world settings. The study objectives were to (1) assess how often PA skills are utilized by fourth-year pharmacy (P4) students on advanced pharmacy practice experiences (APPEs), (2) determine perceived competence in performing PA skills, and (3) examine relationships between grade-point average or post-graduation plans and the number of skills performed and between skill use frequency and self-reported competency. MethodsP4 students completed a questionnaire assessing 13 PA skills. Respondents performing a skill indicated frequency of use and rated their competence using a 5-point scale. Descriptive and bivariate statistics were reported. ResultsThe response rate was 81%. Measuring blood pressure (BP) (76%) and evaluating metered-dose inhaler (MDI) technique (74%) were most commonly performed. Peak-flow meter evaluation (6%) and lymph node examination (2%) were least commonly performed. Measuring BP and evaluating MDI technique had the highest competency ratings (4.6 + 0.7 for both). Lung (3.4 + 0.7) and heart (2.8 + 1) auscultation had the lowest competency ratings. Positive correlations were found between the frequency of skill use and self-reported competence for assessing MDI technique, peripheral pulses, and peripheral edema. No other findings were significant. ConclusionsP4 students reported high perceived competency for PA skills performed frequently during APPEs. Preceptor education, requiring skill use, and encouraging students to proactively identify situations to use skills could increase opportunities for use of PA skills.

The effect of training of metered-dose inhaler technique on asthma control and quality of life in children with asthma: a randomized trial

ABSTRACT The purpose of the study was to determine the effect of two different training styles (with brochure or video) with follow-ups for metered-dose inhaler (MDI) technique on asthma control and quality of life in children with asthma. Training for MDI technique was provided to 66 children (age 7–11 years) by using an MDI Technique Checklist. On the day of training and 4 weeks later, asthma control level (as assessed using the Childhood Asthma Control Test-C-ACT) and quality of life (as assessed using the Pediatric Asthma Quality of Life Questionnaire-PAQLQ) of the children were assessed. MDI Technique Checklist, C-ACT, and PAQLQ scores showed a statistically significant increase in both groups (p <.001), and technique reached the maximum score in the video group. Two different training methods on MDI technique provided the children with improved asthma control and quality of life. Follow-ups should be continued either to maintain or to improve skills.

The Relationship Between Clinical Trial Participation and Inhaler Technique Errors in Asthma and COPD Patients.

BackgroundIncorrect inhaler use is associated with poorer health outcomes, reduced quality of life, and higher healthcare utilisation in patients with asthma and COPD.MethodsWe performed an observational study of pressurized metered-dose inhaler technique in patients with asthma or COPD. Patients were assessed using a six-point inhaler checklist to identify common critical inhaler technique errors. An inadequate inhaler technique was defined as the presence of one or more critical errors. A multivariate logistic regression model was used to determine the odds of an inadequate inhaler technique.ResultsDuring the 14-month study period, 357 patients were enrolled. At least one critical error was executed by 66.7% of participants, and 24.9% made four or more critical errors. The most common errors were failure to exhale completely prior to pMDI activation and inhalation (49.6%), failure to perform a slow, deep inhalation following device activation (48.7%), and failure to perform a breath-hold at the end of inspiration (47.3%). The risk of a critical error was higher in COPD patients (aOR 2.25, 95% CI 1.13–4.47). Prior training reduced error risk specifically when trained by a doctor (aOR 0.08, 95% CI 0.1–0.57) or a pharmacist (aOR 0.02, 95% CI 0.01–0.26) compared to those with no training. Previous clinical trial participation significantly reduced error risk and rate: <3 trials (aOR 0.35, 95% CI 0.19–0.66) and ≥3 trials (aOR 0.17, 95% CI 0.07–0.42). The rate of critical errors was not significantly associated with age, sex, or prior pMDI experience.ConclusionThis study found a high rate of critical inhaler technique errors in a mixed population of asthma and COPD patients; however, prior training and, in particular, multiple previous clinical trial participation significantly reduced the risk of errors.