Improper inhaler technique is associated with poor asthma control and frequent emergency department visits

Abstract

BackgroundUncontrolled asthma remains a frequent cause of emergency department (ED) visits and hospital admissions. Improper asthma inhaler device use is most likely one of the major causes associated with uncontrolled asthma and frequent ED visits.ObjectivesTo evaluate the inhaler technique among asthmatic patients seen in ED, and to investigate the characteristics of these patients and factors associated with improper use of inhaler devices and its relationship with asthma control and ED visits.MethodsA cross-sectional study of all the patients who visited the ED with bronchial asthma attacks over a 9-month period was undertaken at two major academic hospitals in Saudi Arabia. Information was collected about demographic data and asthma management and we assessed the inhaler techniques for each patient using an inhaler technique checklist.ResultsA total of 450 asthma patients were included in the study. Of these, 176(39.1%) were males with a mean age of 42.3 ±16.7 years and the mean duration of asthma was 155.9 ± 127.1 weeks. The improper use of asthma inhaler devices was observed in 203(45%) of the patients and was associated with irregular clinic follow-ups (p = 0.0001), lack of asthma education (p = 0.0009), uncontrolled asthma ACT (score ≤ 15) (p = 0.001), three or more ED visits (p = 0.0497), and duration of asthma of less than 52 weeks (p = 0.005). Multiple logistic regression analysis revealed that a lack of education about asthma disease (OR =1.65; 95% CI: 1.07, 2.54) or a lack of regular follow-up (OR =1.73; 95% CI: 1.08, 2.76) was more likely to lead to the improper use of an asthma inhaler device.ConclusionImproper asthma inhaler device use is associated with poor asthma control and more frequent ED visits. We also identified many avoidable risk factors leading to the improper use of inhaler devices among asthma patients visiting the ED.

Metered dose inhaler-spacer use education effects on achieve asthma control in children

“…It has been reported that most children and adults reduce their mistakes in inhalation device use after getting education about it (31,32). Repeated educations result in better inhalation technique and play a key role in successful inhalation therapy (8,9,22,23,25,30,31). It is reported that repeated education about MDI inhalation technique resulted in a statistically significant improvement in MDI technique scores when compared to single education (33,34).…”

“…Improvement in MDI technique provides better delivery of medication into the lungs thus clinically significant improvement (11). Inappropriate inhalation technique decreases drug delivery in the lungs and decreases the efficacy of medical treatment and hinder better asthma control (7,8,10,11). People with asthma and improper inhaler technique were shown to have poorer symptom control compared to those with good inhaler technique, with a subsequent increase in medical or emergency visits (8,11,20,25).…”

“…In 2011, GINA is focused on patient education about asthma (2). Inhaled treatment has many advantages such as direct fast onset of action due to local delivery high concentration of the drug to the airways with minimal systematic side effects however, use of these medications with improper technique leads to the inefficacy of treatment (5)(6)(7)(8). Inefficient inhaler treatment results in poor asthma outcomes, frequent exacerbations, increased hospitalization rates and medication cost (3,5,(8)(9)(10)(11).…”

A Method to Calculate Adherence to Inhaled Therapy that Reflects the Changes in Clinical Features of Asthma

“…In this case the average use over time is meaningless unless data on the technique of use is also incorporated into the calculation of the adherence. Most electronic recording devices usually do not assess if the inhaler was taken correctly (5)(6)(7)(8)(9)(10)(11)(12). Hence, there is a need to develop a method to quantify adherence that accounts for variations in dosing schedules as well as inhaler user technique.…”

Assessing New Technologies in Aerosol Medicine: Strengths and Limitations

“…81,82 Poor inhaler technique has been associated with poor outcomes. 83 The prescribed drug/device should be affordable and easily available at retail sale points. Licensed independent practitioners should discuss with the patient and family the different platform alternatives that are available for a specific treatment, and they should agree on a specific platform after having discussed the pros and cons.…”