Use Of Metered-dose Inhalers Research Articles

Environmental impact of pressurised metered dose inhalers versus dry powder and soft mist inhalers at a tertiary Melbourne hospital.

The carbon footprint of devices to deliver inhaled respiratory medications has come into focus as climate change has been identified as a worldwide emergency. Metered dose inhalers (MDIs) contain hydrofluorocarbons that have significant global warming potential compared to dry powder inhalers (DPIs) and soft mist inhalers (SMIs), which do not use a propellant gas. A 12-month pharmacy inpatient dispensing audit demonstrated that inpatient MDI use significantly outweighed that of DPIs and SMIs and accounted for approximately 99% of inhaler-related greenhouse gas emissions at our hospital.

Environmentally sustainable opportunities for health systems: Metered-dose inhaler prescribing, dispensing, use and waste at a tertiary academic centre.

The Canadian health sector's carbon footprint is among the highest in the world and is responsible for 4.6% of Canada's total greenhouse gas emissions, a quarter of which is linked to pharmaceuticals, with metered-dose inhalers (MDIs) contributing disproportionally high amounts. To describe MDI prescribing, dispensing, use and waste patterns at a Canadian tertiary care academic hospital. In a retrospective point-prevalence cohort study, 100 consecutive patients discharged from medical and surgical services who were prescribed at least 1 MDI during their admission were included. Data were collected to describe patient demographics, MDI prescribing, dispensing, use and waste patterns. Use and waste data were applied to annual purchasing data to estimate annual usage and waste. Financial cost was computed using local purchasing estimates and carbon cost was calculated using published estimates. In 100 consecutively discharged patients, 315 MDIs were dispensed in total, of which 96 were unused. This represents 61,440 actuations dispensed, with 56,773 (92%) of doses unused or wasted. Waste data were applied to annual estimates, with a calculated annual carbon footprint of 315.8 tons of carbon dioxide equivalent (tCO2e). We estimate that a 20% waste reduction would result in carbon savings of 68.5 tCO2e. If 20% of salbutamol prescriptions were switched to the dry powder inhaler alternative, terbutaline, a 14% reduction in waste would be required to offset the additional monetary cost. This study suggests that 92% of MDI doses are unused and wasted. Opportunities for waste reduction exist and would be associated with both financial and carbon savings.

Impact of nebulization versus metered-dose inhaler utilization on viral particle dispersion in patients with COVID-19.

Conflicting guidance exists regarding the characterization of nebulization as an aerosol-generating procedure and subsequent risk of transmission of SARS-CoV-2 to healthcare workers. This study sought to address whether SARS-CoV-2 viral load distribution was impacted by bronchodilator delivery via nebulizer versus metered-dose inhaler (MDI). Adults infected with COVID-19 were enrolled and received a single dose of albuterol sulfate nebulized solution (2.5mg/3mL via breath-actuated nebulizer with filtered mouthpiece) or albuterol sulfate hydrofluoroalkane inhalation aerosol (90µg/actuation; two puffs via MDI with spacer) in a randomized crossover sequence. Air and surfaces were sampled at predefined locations within patients' hospital rooms to assess SARS-CoV-2 dispersion over three periods (baseline, MDI, and nebulizer). Eleven patients received crossover therapy. Six patients had detectable SARS-CoV-2 RNA during one treatment period (n = 3 each for MDI and nebulizer) and one during both treatment periods. No viral RNA was found in the rooms of four (36.4%) patients. Overall, few environmental samples (17/397; 4.3%) contained detectable viral RNA, with no meaningful differences in positivity rate across periods; RNA genome copy numbers were low in positive samples. No correlation between dispersion and patient clinical status or environmental parameters was observed. In this first prospective trial evaluating viral load distribution following use of nebulizer versus MDI in hospitalized patients with COVID-19, low environmental contamination was found regardless of administration method. Findings support the use of either device when needed to treat patients with COVID-19.

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.

Promoting knowledge of metered dose inhaler (MDI) usage among pharmacy professional students through a mobile app

Introduction Efficient asthma management necessitates optimal usage of metered-dose inhalers (MDIs). As future health professionals, pharmacy students are pivotal in disseminating accurate methodologies for MDI usage. Despite having hands-on experience, there is room to enhance their comprehension, highlighting the need for prompt patient educational interventions. Objective This study aims to evaluate the effectiveness of a mobile app-assisted educational method in improving pharmacy students’ understanding of MDI usage. Methods A pre-experimental study was conducted from March to August 2021 with 45 participants enrolled in the Pharmacist Professional Study Program at the Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta. Using a one-group pretest-post-test design, the study measured the app’s impact on students’ knowledge and MDI usage skills. Results The intervention significantly improved students’ scores on a 9-step MDI usage checklist, with increases ranging from 0.10 to 0.50 across verbal and motor components. A Mann-Whitney U test validated these findings, showing a statistically significant p-value of 0.001. Conclusion The mobile app-assisted educational approach substantially enhanced pharmacy students’ proficiency in MDI use. The significant rise in mean scores for the 9-step checklist, along with the notable p-value, supports the effectiveness of this intervention in healthcare education.

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.

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

Investigate inhalation techniques using different inhalers types and their effect on the course of disease. This cross-sectional study included 110 patients with asthma, chronic obstructive pulmonary disease using the inhaler 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 performed spirometry. 80.9% of patients used metered-dose inhaler, 20.9% - single-dose and 21.8% - multiple-dose dry powder inhaler, 22.7% - soft-mist inhaler. Inhaler errors were made by 80.9% patients. The mean number of mistakes in metered-dose inhaler use was 2±1.6, single-dose powder inhaler -1.5±1.3, multiple-dose dry powder inhaler - 1.25±1.4, soft-mist inhaler - 0.68±0.7 (р=0.003). Age, diagnosis, duration of disease, education level, inhalers usage by relatives have no influence on the inhalation technique. A number of errors was related to female gender (р=0.007) and usage of more than 2 inhalers (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, asthma control, severity of dyspnea by mMRC score, exacerbation rate. Patients with bronchoobstructive diseases perform many inhaler errors, that substantially influences the severity and course of asthma and chronic obstructive pulmonary disease.

An evaluation of the use of inhalers in asthma and chronic obstructive pulmonary disease

ObjectivesInhaled therapy is the treatment of choice for obstructive lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). However, the maximum benefit from such therapy depends on the correct use of inhaler devices. In this study, our primary aim was to evaluate inhaler techniques in patients with asthma and COPD in order to identify common errors. In addition, we investigated the effect of various parameters on the rate of inhaler misuse. MethodsWe enrolled a total of 300 asthma/COPD patients, who presented at the Chest Diseases and Family Medicine Outpatient Clinics of a tertiary hospital located in Ankara, Turkey. We used a face-to-face survey that included questions about sociodemographic features and inhaler therapy. Subsequently, we requested patients to demonstrate how they use their inhalers and assessed their inhalation technique according to checklists. ResultsOf the 300 patients, 70.2% used their inhaler drugs incorrectly. The rate of misuse among metered dose inhaler (MDI) users was significantly higher than those using dry powder inhalers (DPIs) (77.6% vs 64%; p = 0.002). When DPI devices were analyzed, the rates of misuse were significantly higher in Handihaler users (p = 0.012) and Diskus inhaler users (p = 0.009) when compared to Sanohaler users. Gender, type of disease (asthma/COPD), duration of inhaler use, and duration of illness had no impact on the rate of misuse. However, an advanced age (>60 years old), a level of education lower than high school, and the use of MDI were all identified as factors associated with misuse. The most common mistake was ‘failing to breath out before inhalation’ for all types of devices (for MDI: 66.7%, and for DPI: 71.1–82.8%). ConclusionsThe rate of inhaler drug misuse was high. The identification of factors associated with misuse could provide information to implement appropriate actions to reduce the rates of misuse.

Impact of choice of inhalers for asthma care on global carbon footprint and societal costs: a long-term economic evaluation

Background While effective asthma control medications reduce the burden of asthma, a significant subgroup of these treatments, namely metered-dose inhalers (MDIs), produce substantial greenhouse gas (GHG) emissions, thus contributing to climate change. This study quantified the global climate impact (i.e. carbon dioxide equivalent [CO2e] emissions) and costs of long-term status quo asthma inhaler use versus alternative scenarios substituting MDIs with propellant-free dry powder inhalers (DPIs). Methods Three scenarios were evaluated across 10-year (2020–2030) and 50-year (2020–2070) time horizons: A (status quo inhaler use), B and C (2% and 5% year-over-year substitution of MDIs with DPIs, respectively). Global inhaler volumes and costs at baseline were sourced from IQVIA, then projected using UN and WHO trends in per capita GDP, urbanization, and asthma population growth. Inhaler spending was assumed to fall by 90% following generic entry in 2030. The carbon footprint per inhaler and health damage factors for disability-adjusted life years (DALYs) were derived from literature. The US government’s central and high-impact estimates for the social cost of carbon (SCC) were used to calculate emissions costs. Results Over 50 years, scenario A resulted in 826 million tonnes of CO2e emissions globally, with an associated SCC between 21% and 65% of the projected global spending on asthma inhalers. In comparison, CO2e emissions were reduced by 38% and 58% in Scenarios B and C, respectively, and DALYs improved by 33 and 51%. Depending on SCC estimates, Scenarios B and C increased global costs by 7.3% and 16.5%, respectively (central SCC), or decreased costs by 4.2% and 2.6% (high-impact SCC) versus Scenario A. Over 10 years, Scenario A resulted in 97 million tonnes of CO2e emissions globally, with an associated SCC between 4.4% and 12.2% of projected spending. In comparison, Scenarios B and C were associated with 12% and 24% reductions in CO2e emissions and improvements in DALYs by 11.5% and 22.7%, respectively. Conclusions Global efforts by environmental and health-policy decision-makers to substitute currently available MDIs with DPIs for asthma control would result in substantial reductions in GHG emissions with manageable costs, or potential cost savings, depending on the SCC. Policies that decrease use of MDIs warrant global attention.

The environmental impact of inhalers for asthma: A green challenge and a golden opportunity.

The propellants in metered-dose inhalers (MDIs) are powerful greenhouse gases, which account for approximately 13% of the NHS's carbon footprint related to the delivery of care. Most MDI use is in salbutamol relievers in patients with poorly controlled disease. The UK lags behind Europe in this regard, with greater reliance on salbutamol MDI and correspondingly greater greenhouse gas emissions, roughly treble that of our European neighbours. There has been a broad switch towards MDIs in asthma treatment in the UK over the last 20 years to reduce financial costs, such that the treatment for two-thirds of asthma patients in the UK is dominated by salbutamol MDI. Strategies that replace overuse of reliever MDIs with regimes emphasising inhaled corticosteroids have the potential to improve asthma control alongside significant reductions in greenhouse gas emissions. Real-world evidence shows that once-daily long-acting combination dry-powder inhalers (DPIs) can improve compliance and asthma control, and reduce the carbon footprint of care. Similarly, maintenance and reliever therapy (MART), which uses combination reliever and inhaled steroids in one device (usually a DPI), can simplify therapy, improve asthma control and reduce greenhouse gas emissions. Both treatment strategies are popular with patients, most of whom would be willing to change treatment to reduce their carbon footprint. By focussing on patients who are currently using high amounts of salbutamol MDI and prioritising inhaled steroids via DPIs, there are golden opportunities to make asthma care in the UK more effective, safer and greener.

Correlation of Metered Dose Inhaler Use Technique and Asthma Control Level in Asthma Patients at a Hospital in Bandung, West Java, Indonesia

Background: Asthma is still a major health problem in global population, including Indonesia. Antiasthma drugs available in various dosage forms, including inhaler. However, several problems related to inhalation route were found due to its unique device form and spesific use technique. One of the major problems related to inhalation route is inappropriate use technique of inhaler device, which could lead to treatment failure. Therapy outcome can be measured through Asthma Control Test (ACT). Objectives: This study was aimed to evaluate correlation between metered dose inhaler (MDI) use technique and asthma control level in patients. Material and Methods: A cross-sectional analytic study was conducted in May - June 2021. Thirty patients who met inclusion criteria were enrolled in this study. Patients’ MDI use technique and asthma control level were evaluated using a valid and standardized questionnaire. Statistics analysis was performed to determine the correlation between MDI use technique and asthma control level. Results: This study showed that most of asthmatic patients were women in older age, with mild asthma severity for more than 10 years. The most prevalent medication used was Fenoterol HBr, followed by salbutamol, and salmeterol/fluticasone combination. Inappropriate MDI use was found in 70,0% patients, with major problem found in patients’ breathing technique before and during MDI use. Asthma control test was performed and showed that 90,0% of asthmatic patients involved in this study have an uncontrolled asthma. Statistical analysis using Pearson product-moment correlation test showed a positive correlation between proper use of MDI and asthma control level (r=0.425, p<0.05). Conclusions: Patient who properly use MDI may have a higher score in asthma control test, thus have a better control of asthma. This study emphasized pharmacist role as patient educator in ensuring appropriate inhaler use in order to achieve therapeutic goals.

Pathways for Improving Inpatient Pediatric Asthma Care (PIPA): A Multicenter, National Study

This study was aimed at improving inpatient asthma care in the pediatric population through the implementation of visual evidence-based guidelines, called pathways, in diverse hospital settings.Pediatric patients (ages 2–17) hospitalized with a primary diagnosis of asthma in diverse hospital settings across the United States.From January 2018 through March 2019, clinicians from >250 hospitals that varied in size, location (urban versus rural), ownership (private versus nonprofit), and type (community versus children’s) were recruited to participate in the study. Clinicians were identified through the Value in Inpatient Pediatrics electronic mailing list. Participating hospitals were given evidence-based pathways and order sets as well as various support services for pathway implementation (educational seminars, quality improvement training, and monthly video conferences). Data on hospital characteristics were collected through a survey of implementation leaders. Outcomes data were collected via chart review. The primary outcome was inpatient length of stay (LOS), and secondary outcomes included early administration of bronchodilator via metered-dose inhaler (MDI), screening for secondhand tobacco smoke exposure, referral of caregivers to smoking cessation resources, hospital readmission within 7 days of discharge, and emergency department revisits within 7 days of discharge.A total of 85 hospitals were enrolled in the study, and 68 hospitals completed the study (participated for the full 15-month duration). There was diversity in the types of hospitals that completed the study in terms of size, type, and location. Pathway implementation was not associated with significant changes in LOS, but it was associated with statistically significant increases in early administration of bronchodilators versus MDI as well as caretaker referral to smoking cessation resources. Specific interventions, including implementation of MDI dosing guidance and reminders for smoking cessation resources, were associated with improvements in early administration of MDI and referral to smoking cessation resources, respectively. These improvements were noted with pathway initiation and not just study enrollment. Hospital level analysis revealed that most hospitals (65%) had significant improvements in >1 outcome. Only 2 hospitals had increases in 7-day hospital readmission or emergency department revisits (balancing measures).Overall, pathway implementation was not associated with statistically significant changes in LOS but was associated with improvements in the quality of care being provided, specifically in increasing early administration of bronchodilators via MDI and referring caretakers to smoking cessation resources.Childhood asthma is a major cause of pediatric hospitalization and associated health care costs. Pathways or evidence-based visual guidelines for the treatment of asthma have previously been shown to improve the quality of care of pediatric asthma patients. Large-scale quality improvement projects are extremely difficult to implement because of variations at each site. However, standardization of care can be attained through automated measures, particularly within the electronic medical record. Similar to other large-scale projects across multiple sites, this project did not move the needle overall for their predetermined primary outcome measure, but it did reveal that pathways helped improve other quality care measures, such as early MDI use and provision of smoking cessation resources. Additionally, this study reveals that use of pathways may be beneficial across a diverse array of hospitals, not just large, tertiary care children’s hospitals.

Medication Administration With Inhalers or Nebulizers


 Delivery of medication via metered-dose inhalers to children or adults with asthma, or adults with chronic obstructive pulmonary disease at emergency departments or intensive care units, may be as effective as nebulizers in terms of clinical parameters and health care resource use.
 Limited data on adverse events showed no significant differences between metered-dose inhalers and nebulizers.
 No evidence was found on the clinical effectiveness of dry powder inhalers in comparison with nebulizers or metered-dose inhalers.
 No evidence was found on the cost-effectiveness of medication administration via metered-dose inhalers, nebulizers, or dry powder inhalers in comparison with each other.
 No evidence-based guidelines with recommendations regarding the comparative use of metered-dose inhalers, dry powder inhalers, or nebulizers for administration of medication were identified.

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.

Evaluation of inhaler use technique among patients with chronic obstructive pulmonary disease

Introduction: Chronic obstructive pulmonary disease (COPD) is a common medical problem. The improper implementation of inhaler techniques thatare used in such patients leads to the reduced effect of medicines. This study was conducted to evaluate the correct use of various inhalers among COPD patients. Materials and Methods:This observational, cross-sectional study was carried out on 96 patients with COPD aged over 40 years. The samples were selected using asystematic random samplingmethod from patients with COPD referring to the clinics of Ghaem and Imam Reza hospitals, Mashhad, Iran, from March 2018 to March 2019. The subjects were informed that their participation in the study was voluntary. These cases were under the treatment of using at least one inhaled medicine for a month or more. The adopted technique of applying four types of inhalers was evaluated by a standard checklist. The patients' performance scores of all procedures were recorded, and the collected data were analyzed in SPSS software (version 16). Results: Our study revealed that more than 98% of patients used metered-dose inhaler (MDI) spray (P=0.05). The patients' scores on the correct use of MDI, Diskus, Turbuhaler, and HandiHaler inhalers were estimated at 68, 77, 87, and 90%, respectively. The most common mistakes in using MDI and HandiHaler inhalers were related to the 'holding the breath' and taking a deep inhale' steps after using the inhaler, respectively. Conclusion: Physicians must evaluate and modify the use of inhalers in every COPD patient. It is recommended that easy-to-use inhalers, such as HandiHaler, be prescribed for such patients.

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.

An evaluation of the technique of use of metered dose inhaler administration in bronchial asthma children

Background: Inadequate understanding and performance of drug administration using metered-dose inhaler (MDI) in paediatric population affects therapeutic outcome. Hence, this study aimed to evaluate the impact of two educational interventional methods for usage of MDI in paediatric patients of bronchial asthma.Methods: This prospective, interventional study was done in paediatric asthma patients who were prescribed drugs with (MDI) with/without spacer at outpatient department of pediatrics. Patients were divided in group A (video) or group B (leaflet) as per random table method and method to use MDI was assessed by using checklist as per WHO guide to good prescribing at baseline. Investigator taught the technique by a video (group A) and leaflet (group B) to the selected population. Patients were followed up after 15 days and assessed for use of MDI using the same checklist. Data were analysed by using paired and unpaired ‘t’-test.Results: A total of 100 pediatric asthma patients were included in study group A (50) and group B (50). The average no. of steps (WHO checklist) followed was significantly improved at post intervention in both group A (with spacer, p&lt;0.0001) as well as B (without spacer, p&lt;0.05). Although average no. of steps followed were more in group A, no significant difference was found between two groups after intervention.Conclusions: As video is an audio-visual method of demonstration, and hence help us memorise the step of inhalational technique in pediatric patients. Repeated demonstration/education to patients/caregivers may improve the method of MDI usage.

Clinical course of asthma in 4 cases of coronavirus disease 2019 infection

Clinical course of asthma in 4 cases of coronavirus disease 2019 infection

PRS67 BARRIERS TO AND COMPETENCY WITH THE USE OF METERED DOSE INHALER AMONG ADULT ASTHMATIC PATIENTS IN ETHIOPIA

The aim of this study was to assess the barriers to and competency with the use of Metered Dose Inhaler (MDI) and its impact on disease control among adult asthmatic patients. A prospective cross-sectional study was conducted in University of Gondar comprehensive specialized hospital outpatient department (OPD) chronic follow up from 12-March-2018 to 15-May- 2018. Patients were interviewed face to face with questions which determined their competency, asthma control level and barriers for inhaler use. Overall, 307 asthmatic patients were included in the study. More than half of participants were females, 170 (55.4%) and lived in urban area 185 (60.3%). The mean age of the respondents was 51.77 with a standard deviation of ±15.40. The cost of medication, 282 (91.9%) and the perception that medication should be used in response to symptoms but not on a regular basis 277 (90.2%) were the most identified barriers. Only 56 (18.2%) were competent for Metered Dose Inhaler use (MDIU) and 17 (5.5%) patients had well controlled asthma. Being not competent AOR 0.168[0.41-0.687] was one of the factors decreasing asthma control. Generally from this study, cost of the medication and the perception that medication should be used only for symptoms were the major identified barriers that affect the MDI use among asthmatic patients. Patients show very poor competence to their MDI which in turn led to poor asthma control. So, patients need to be taught the correct inhaler technique in the hospital and pharmacy while they came for follow up every time.