Predictors of correct technique in patients using pressurized metered dose inhalers

Abstract

BackgroundCorret inhaler technique is recommended by guidelines for optimum asthma care. The objective of the study is to determine real life predictors of correct pressurized metered dose inhaler (pMDI) technique in Asthma and COPD patients.MethodsTwo hundred eight adult patients aged 18+ from respiratory outpatients (69.2%) and the community on regular pMDI for a diagnosis of Asthma (78.9%) or COPD, were recruited. A questionnaire containing 31 possible predictors was administered and pMDI technique with or without spacer was observed by trained researchers on 12 point steps, of which 4 were considered critical.Results23.1% of patients had no errors in inhaler technique and 32.2% had no critical errors. Patients had a median of 10 correct steps (IQR9-11), and 3(IQR2-4) correct critical steps. Using binary logistic regression the predictors of 10 correct steps were, other healthcare professional (pharmacist, nurse, physiotherapist) explained OR 3.73(1.63–8.54, p = 0.001), male gender 2.70(1.35–5.39, p = 0.004), self-score 1–10 1.21(1.05–1.39, p = 0.007), spacer use 0.38(0.19–0.79, p = 0.007), inhaled steroid 3.71(1.34–10.25, p = 0.01), heart disease 0.31(0.13–0.77, p = 0.01), pneumococcal vaccine 2.48(1.0–6.15, p = 0.043), education level 1–4 1.44(1.00–2.06, p = 0.05) and respiratory physician explained 0–7 times, 1.11(0.99–1.26, p = 0.08). Using ordinal logistic regression, predictors for correct critical steps 0–4, were: technique self-score 1–10 1.2(1.05–1.42, p = 0.006), inhaled corticosteroid use 2.78(1.1–7.31, p = 0.03) and education level 1–4 1.41(1.02–1.95, p = 0.03 Times respiratory physician explained inhaler technique 0–7 1.1(0.98–1.24, p = 0.1), married status 1.55(0.85–2.82, p = 0.15), hypercholesterolaemia 0.52(0.25–1.01, p = 0.054) and male gender 1.76(0.97–3.18, p = 0.06).ConclusionsKnown predictors of correct pMDI use, such as gender and education level were confirmed, while age and concomitant use of dry powder inhaler were not. Pneumococcal vaccination and awareness of steroid side effects were possible novel positive predictors, while the use of a spacer and co-morbidity with heart disease were found to be negative predictors. Patients’ self-assessment correlated well with actual performance. This information may be useful in defining approaches to optimize inhaler techniques which are so susceptible to human error.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0386-6) contains supplementary material, which is available to authorized users.

The impact of the clinical pharmacist on the use of inhalers among asthmatic patients in Alkarak region in the South of Jordan

“…In this study, nearly half of the patients do not perform the essential steps for MDIs correctly (shake the inhaler and remove the protective cap, inhale slowly and simultaneously active the canister), and this result is in agree with what others found . One of the most common problems was failure to hold breath for 5–10 s. This finding on an essential step was also seen in previous studies .…”

Asthma and COPD Patients’ Perception of Appropriate Metered-Dose Inhaler Technique

“…One study found that the male gender was a predictor for several correct steps in inhalation technique but not critical ones. 32 This could be explained by the fact that, in general, men have a better hand-to-eye coordination 33 and spatial abilities than women. 34…”

Checking Inhaler Technique in the Community Pharmacy: Predictors of Critical Errors

“…Multiple studies report that more patients make errors with dry powder inhalers [10,15], while others suggest that patients make more errors with metered dose inhalers [2,13,16]. The impact of age on proper inhaler technique is another point of contention, however, a recent systematic review favors a negative correlation between older age and proper inhaler technique [5,[17][18][19].…”

“…Health care practitioners are failing their patients who suffer from pulmonary conditions. Conversely, studies have also shown that health care practitioners can improve the inhaler technique of their patients and reduce errors [9,18,24,25]. Community pharmacists are particularly situated to regularly check inhaler technique when patients drop off new inhaler prescriptions or pick up refills.…”