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

Abstract

PurposeDry powder inhalation is a cornerstone of treatment in patients with COPD. This study was undertaken to study the knowledge and practice of dry powder inhalation among such patients.Patients and methodsThe current study was a cross-sectional study conducted in Western Regional Hospital, Pokhara, Nepal. The study was conducted among 204 COPD patients (outpatients and inpatients) aged ≥20 years who had been using rotahaler, a dry powder inhaler device, and a purposive sampling technique was used. Data were collected from February 28, 2016, to March 26, 2016. A questionnaire was administered by the interviewer to assess the knowledge about dry powder inhaler (DPI) and inhalation while a Dutch Asthma Foundation observation checklist for rotahaler was used to evaluate the practice of dry powder inhalation. The collected data were analyzed using descriptive statistics and inferential statistics (chi-square test).ResultsFindings from the study showed that a low proportion of the respondents had accurate knowledge and correctly practiced inhalation technique (3.9%). However, majority of the respondents (77.5%) performed the critical steps correctly. The correct practice of dry powder inhalation was associated with younger age (p=0.008), urban residence (p=0.024), and literacy (p=0.012). The practice was comparatively more accurate among those who received practical classes/demonstration on the inhalation technique from health care providers (p<0.001).ConclusionBased on the study findings, it was concluded that COPD patients attending Western Regional Hospital possessed satisfactory knowledge but poor technique of dry powder inhalation. The most important modifiable factor for incorrect practice was a lack of demonstration on inhalation technique by the health care provider. Therefore, it is necessary for health care providers to supplement verbal instruction on dry powder inhalation with demonstration and re-demonstration from the patients to improve the knowledge and practice of dry powder inhalation for COPD patients.

Understanding Practice Patterns of COPD: A Survey of Physicians in Nepal, Sri Lanka and Malaysia

“…While choosing the right device for their COPD patients, most physicians relied on pMDIs with or without a spacer. While many of these choices can be attributed to the availability of certain drugs and their combinations in specific inhalation devices, we and many of the doctors in the region believe that there is a high inspiratory flow required to activate the DPI device, which is very difficult for a patient with COPD to generate [ 5 , 7 , 13 ]. For some patients, many physicians preferred home nebulisation with SABA and SAMA combinations.…”

<p>Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD</p>

“…Numerous studies have reported poor inhaler technique is present in up to twothirds of patients with COPD. [25][26][27][28][29] Experience in our COPD clinic past 10 years indicates that the prevalence of poor inhaler technique is well above 90% regardless of socioeconomic and/or educational background. Repeated and dedicated education is required to make clinically significant differences.…”

Impact of Sex on Proper Use of Inhaler Devices in Asthma and COPD: A Systematic Review and Meta-Analysis

“…Of the 128 potentially relevant records identified in the initial search, 12 studies were deemed eligible for qualitative and quantitative syntheses. Data obtained from 5724 asthmatic patients and 847 COPD patients were extracted from 11 observational crosssectional studies [51][52][53][54][55][56][57][58][59][60][61] and 1 RCT [31]. The study by Harb et al [31] was interventional and randomized in design; however, the error frequency in inhaler technique was assessed at baseline, prior to verbal and demonstrative instructions on correct performance.…”

“…The investigated inhaler devices included DPI (Aerolizer, Accuhaler, Breezhaler, Diskhaler, Diskus, Easyhaler, Ellipta, Genuair, HandiHaler, Rotahaler, and Turbuhaler), MDI or pressurized MDI (pMDI) with or without a spacer (such as Ventolin, Atrovent, or Combivent), and SMI (Respimat). The inhaler technique was evaluated for DPI in 11 studies [31,51,[53][54][55][56][57][58][59][60][61], for MDI in 8 studies [31,[51][52][53]55,56,58,60], and for SMI in 2 studies [31,55]. Data on bronchoreversibility were not reported in Table 1 as none of the analyzed studies included this information.…”

“…There were some concerns for the risk of bias in the measurement of the outcome and no information concerning deviations from intended intervention. [31,54,57,58] or one critical error (B) [31,55] in the use of inhaler devices in COPD. DPI: dry powder inhaler; MDI: metered-dose inhaler; OR: odds ratio; SMI: soft mist inhaler; 95%CI: 95% confidence interval.…”