The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

Abstract

Background Subjects’ improper usage of their metered‐dose inhalers (MDI) is considered a chief cause of poor asthma control. The work presented here aims to evaluate the effect of MDI verbal counselling on subjects’ lung function and inhalation technique. Method A total number of 900 asthmatic subjects (450 female) were gathered from University hospital outpatient clinics from January 2017 to May 2019 with a mean (SD) age 45.2 (17.1) years old. They were divided into two groups. The first was monthly asthma follow‐up, for three visits, (450 (266 females) subjects). The other group was monthly asthma follow‐up, for three visits plus MDI inhalation technique verbal counselling (450 (184 female) subjects). At the beginning of studying group 2 and at every monthly visit (three visits), each subject was asked to show the investigator his MDI inhalation technique and the number of mistakes was noticed and adjusted. Additionally, at each visit, their forced expiratory volume in one second (FEV1) as a percentage of the forced vital capacity (FVC) and peak expiratory flow (PEF) were measured. Results No subject dropped out from group 2; however, 95 subjects dropped out from group 1 with no improvement in the lung function tests. The mean number of accurate steps of the MDI inhalation technique observed in group 2 was improved significantly (P < .001) as the number of visits increased particularly in children. “Start to inhale slowly, through the mouth and at the same time press the canister to actuate a dose and maintain a slow and deep inhalation, through the mouth, until the lungs are full of air (This should take an adult 4‐5 seconds)” was the common repetitive mistake. There was a significant improvement (P < .05) in the lung function test scores after the counselling in group 2, especially in old subjects. Conclusions MDI’s counselling must be continually offered to the asthmatic subject at any possible chance to improve and sustain the optimal MDI inhalation technique and probably improve subjects’ lung function score.

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

“…The frequency of training or verbal counselling sessions for asthmatic subjects has a significant effect on the score of lung functions and the mean number of inhaler technique mistakes of pMDI. This improvement was observed in all included studies 27‐36 . The current meta‐analysis study based on 10 studies including 2423 asthmatic subjects of them 1937 asthmatic subjects performed a minimum of two visits; asthmatic subjects at visit 2 had a significantly higher improvement in the pMDI inhalation technique and lung function score compared with visit 1.…”

“…The improvement further increases in visit 3 compared with visit 2. This effect was observed primarily in all populations 27‐36 . The continuous improvement from visit 1 to visit 3 highlights the importance of contentiously pMDI verbal counselling provided to the asthmatic patients at every possible opportunity as recommended by GINA 7 .…”

“…A total of 2805 unique studies were identified, of which 10 studies satisfied the inclusion criteria and were included in the study 27‐36 . The details of the included studies are shown in Table 2.…”

“…Of the 10 studies, all studies observed improvement in asthmatic patients’ pMDI inhalation technique and pulmonary functions with continuous pMDI verbal counselling, and this was statistically significant across all groups 27‐36 . Asthmatic subjects who performed continuous pMDI verbal counselling sessions had a significantly lower number of pMDI inhalation mistakes in subsequent counselling visits; 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) with high heterogeneity ( I 2 = 99%).…”

“…Only English language articles were considered. Also, the numbers of steps of the inhalation techniques were not consistent in all the studies, that hinder us from comparing each step results; however, all the study showed that inhaling slowly, while releasing the pMDI dose was the hardest step and need a lot of counselling to be properly performed 27‐36 . Several studies did not report data on physical activity.…”