Effect of verbal counselling on metred‐dose inhaler proper use and lung function test amongst asthmatic patients: A meta‐analysis

Abstract

Introduction The main cause of poor asthma control is mostly related to the inability of the asthmatic subjects to use their metred‐dose inhaler (pMDI) correctly. The present study aimed to evaluate the role of contentious pMDI verbal‐counselling on the pMDI inhalation technique and pulmonary functions of asthmatics. Methods Through a systematic literature search up to December 2020, 10 studies with 1937 asthmatic subjects, who had at least two pMDI inhalation technique verbal counselling sessions (visits), were identified reporting relationships between contentious pMDI verbal counselling, and the number of inhalation technique mistakes and lung functions score. Mean difference (MD) with 95% confidence intervals (CIs) was calculated comparing counselling visits results using the continuous method with a random effect model. Results Visit 1 had a significantly higher mean number of mistakes compared with visit 2 (MD, 19.98; 95% CI, 11.54‐28.41, P < .001); Also, visit 2 had a significantly higher mean number of mistakes compared with visit 3 (MD, 12.17; 95% CI, 9.31‐15.02, P < .001). The extent of improvement in the inhalation technique was higher between visits 1 and 2 compared with that between visits 2 and 3. The impact of continuous verbal counselling was also observed on the forced expiratory volume in one second as percentage of vital capacity [(MD, −5.56; 95% CI, −6.50 to −4.61, P < .001) between visits 1 and 2 and (MD, −6.40; 95% CI, −7.71 to −5.10, P < .001) between visits 2 and 3] and the peak expiratory flow rate [(MD, −11.47; 95% CI, −18.73 to −4.22, P < .001) between visits 1 and 2 and (MD, −16.53; 95% CI, −25.80 to −7.26, P < .001) between visits 2 and 3]. The extent of improvement in lung functions was similar between visits 1 and 2 and visits 2 and 3. Conclusion Based on this meta‐analysis, Continuous pMDI verbal counselling, at every possible opportunity, is a must since lung functions and pMDI inhalation technique improvements were observed with continuous pMDI verbal counselling.

Advanced counselling using training device and smartphone application on inhalation technique from metered‐dose inhaler with spacer equipped with different interfaces in asthmatic children

“…Finally, although many children could not achieve the target of maintaining inhalation for 5 seconds, we observed a significant increase ( P < .05) in inhalation time (the mean total number of seconds) recorded by Trainhaler smartphone application from the second visit in the mouthpiece group and the third visit in facemask group. This proves that positive reinforcement by the sound and the smartphone application can be more useful in instructing asthmatic children 11,25,26 …”

“…For the facemask group and also concerning step 3, the percentage of mistakes decreased significantly also from 84% in visit 1 to 22% in visit 2 and the mistakes disappeared totally in the third visit between patients in this group with 100% improvement in a total number of mistakes from the first to the third counselling visits in this step as shown in Table 1. This gradual significant decrease in percentages of errors can be explained by the positively strong effect of repeated regular counselling visits for children in both study groups 11,25,26,40‐44 …”

“…This gradual significant decrease in percentages of errors can be explained by the positively strong effect of repeated regular counselling visits for children in both study groups. 11,25,26,[40][41][42][43][44] One of the most important steps in the inhalation technique in the facemask group is step 7 which "Ensure the mask tightly cover your nose and mouth". We observed that 80% of children in the facemask group in our study performed this step wrongly in the first counselling visit.…”

“…Asthmatic patients counselling via the traditional verbal manner alone was not found to provoke the desired expected results in the prevention of errors concerning inhalation technique 24,25 . For achieving better counselling results and benefits, patients including children need to be counselled on regular basis through consecutive repeated visits with the aid of modern auxiliary counselling apparatus such as the Flo‐tone (whistle producing device) and the Trainhaler smartphone application in combination with classic oral verbal counselling 26‐28 …”

“…24,25 For achieving better counselling results and benefits, patients including children need to be counselled on regular basis through consecutive repeated visits with the aid of modern auxiliary counselling apparatus such as the Flo-tone (whistle producing device) and the Trainhaler smartphone application in combination with classic oral verbal counselling. [26][27][28] It should be realised that using MDIs with spacers (through mouthpiece or facemask) cannot be the magic solution for all MDIs inhalation approach problems. Rather, the spacer can allow for new patient mistakes such as the wrong installation of gadgets, wrong fitting of spacer facemasks, inadequate inhalation duration, long time left between releasing drug dose and inhalation from the spacer and the discharging of many drug doses into spacer before inspiration.…”