Assessment of Inhalation Techniques in Copd Patients Using Metered-Dose Inhaler and Rotahaler at a Tertiary Care Hospital in Nepal

Abstract

Inhalation technique is main therapy of chronic obstructive pulmonary disease (COPD). Incorrect usage of inhaler devices might have a major influence on the clinical effectiveness of the delivered drug. This issue is poorly addressed in management guidelines. The present study was carried out with an objective to assess the inhalation techniques in hospitalized patients with COPD using Metered Dose Inhalers (MDI) and rotahaler. The study consists of all hospitalized patients diagnosed with COPD above 40 years who are using MDI and rotahaler. The study was an institution based prospective and descriptive study done for 8 weeks. The data of the study was analysed using SPSS 20.0 version and Microsoft Excel 2007. Of 100 patients with COPD (mean age 68 years), most of the patients were illiterate (75%) with smoking habit (36%) and smoking history (48%). 84% patients do not use their inhalers correctly, the most common errors being "not exhaling to residual volume" and "not holding breath for 5 seconds". While using MDI, apart from above mentioned errors, the other frequent errors were not continuing slow and deep inhalation, not shaking the inhaler and not inhaling slowly and pressing canister. While using rotahaler, the other common errors apart from afore mentioned errors were not inhaling powder forcefully and deeply and not exhaling away from mouth piece. From the present study it can be concluded that incorrect inhalation techniques is common among COPD patients. The success of COPD management is highly dependent on correct use of inhalers. Thus, trainings, verbal instruction and technique assessment and reassessment are considered necessary to make patients use their inhalers correctly.

Knowledge and practice of dry powder inhalation among patients with chronic obstructive pulmonary disease in a regional hospital, Nepal

“…Regarding the single step, most commonly committed error was not being able to exhale to residual volume (76.5%). Similar results have been reported in other studies 18,19,22,23. The second most frequently committed error was not being able to hold one’s breath for 10 seconds (64.1%).…”

“…Regarding practice, the correct use was associated with younger age ( p =0.008),18,24–26 an urban area of residence ( p =0.024),20 and literacy ( p =0.012) 18,20,26–29. Poor coordination and decline in cognition with increasing age may have resulted in a poor inhalation technique.…”

“…In regard to the essential items, the most frequently committed error was in the step, inhale forcefully and deeply 18,23,24. This error halts the deposition of inhaled drug into the lungs, resulting in poor treatment outcome.…”

“…The sample size was based on a single population estimation formula 21. Based on the findings in Tribhuvan University (TU) Teaching Hospital, Nepal, the percentage of patients who demonstrated a correct inhalation technique was 14% 18. Assuming the prevalence of correct DPI (rotahaler) use among COPD patients, with allowable error of 5% at 95% CI, and adding 10% non-response rate, the final sample size was 204.…”

Pharmacist Led Intervention on Inhalation Technique among Asthmatic Patients for Improving Quality of Life in a Private Hospital of Nepal

“…In case of dry powder inhaler the most commonly mistaken step was "Breathe out gently to residual volume away from the mouth piece" which is similar to ndings of studies by Palen et al [23]; Pun et al [25] and Sapkota and Amatya [26] where 66, 84, and 61% participants respectively made error in exhaling to residual volume. When mistakes are done during the inhalation procedure, signi cant amount of drugs may fail to reach the lungs.…”