Association of Asthma Control and Metered-Dose Inhaler Use Technique among Adult Asthmatic Patients Attending Outpatient Clinic, in Resource-Limited Country: A Prospective Study

Abstract

Asthma is a heterogeneous disease which is characterized by chronic airway inflammation. It is a common chronic respiratory disease affecting 1–18% of population in different countries. It can be treated mainly with inhaled medications in several forms, including pressurized metered-dose inhaler (MDI). Patients encountered difficulty in using inhaler devices even after repeated demonstration and/re-evaluation. This could highly compromise patient treatment outcome/asthma control. To evaluate relationship between MDI use technique and asthma control among adult asthmatic patients who attend respiratory clinic in Jimma University Medical Center (JUMC), Southwest Ethiopia. A prospective observational study was conducted from March to August 22, 2018. All adult asthmatic patients who met the inclusion criteria were included in the study. Patient baseline assessment was conducted (patient demography, inhalation technique, adherence, and asthma control status). Inhalation technique was obtained using a standard checklist of steps recommended in National Institute of Health (NIH) guidelines. Patient adherence using asthma inhalation test and asthma control status was assessed by 2017 GINA guideline. Independent predictors of outcome were identified, strength of association between dependent and independent variables was determined by using ordinal logistic regression analysis, and statistical significance was considered at P<0.05. One hundred forty patients were included in the analysis. Among these, 26 (18.4%) patients were controlled, 65 (46.1%) partially controlled, and 35% uncontrolled. Proportion of patients with uncontrolled asthma were higher among inefficient as compared to efficient, whereas patients with controlled asthma were higher among efficient as compared to inefficient. Asthma control status is significantly associated with inhalation technique (P=0.006). Since most of the patients were inefficient and it is significantly associated with asthma control status, the hospital tried to adopt video MDI teaching program, and the patient should ask healthcare professionals how to take medication and they should bring their device to receive demonstration during visit. Health professionals should re-evaluate the patient during their hospital visit and encourage bringing their device to give demonstration.

Practice on Metered Dose Inhaler Techniques and Its Associated Factors among Asthmatic Patients at Debre Markos Comprehensive Specialized Hospital, East Gojjam, Ethiopia: A Prospective Study

“…is discrepancy might be due to the sociodemographic dissimilarities between the two populations, i.e., in our study, more than two-thirds of the patients are attending secondary school but in the study done at Jimma, and more than half of the participants were illiterate. In another study done at Jimma, 61.5% were efficient in using inhalers which is in line with our finding (95% CI: 57-71%) [17].…”

“…The commonest error was found to not inhaling slowly, simultaneously not pressing the canister, and failing to breathe in slowly and deeply which was committed by 69.28% of patients. The next frequent error was leaning head slightly back (49.3%) and taking the inhaler out of the mouth, and holding the breath for 5–10 sec was the third most missed step which accounts for 38.6% [ 17 ].…”

Practice on Meter Dose Inhaler Techniques and Its Associated Factors Among Asthmatic Patients at Debre Markos Comprehensive Specialized Hospital, East Gojjam, Ethiopia: A Prospective Study.

“…In another study done at Jimma 61.5 %were efficient in using inhaler which is in line with our finding CI 95% (57-71%). 17 In our study, most of the patients believe that they can use the inhaler correctly, but only 108 (65.1%) patients use the inhaler effectively and the remaining 58(34.9%) were using the inhaler ineffectively. The commonest mistake encountered was failing to check labels and expire dates followed by not withholding breath for 10 seconds.…”

“…The next frequent error was lean head slightly back, 49.3%, and take the inhaler out of the mouth and hold the breath for 5-10 sec was the third most missed step which accounts for 38.6%. 17 There are limited research findings to determine knowledge, and practice towards inhalation techniques among asthmatic patients in Ethiopia and specifically, there is no study at comprehensive specialized hospital (DMCSH). There is repeated exacerbation of asthma in patients who have followed up at DMCSH who are on treatment.…”

Correlation of Metered Dose Inhaler Use Technique and Asthma Control Level in Asthma Patients at a Hospital in Bandung, West Java, Indonesia

“…Furthermore, it will lead to a poor asthma control levels as therapeutic outcomes (Coelho and Carvalho, 2011;Lavorini, et al, 2008;Giraud and Roche, 2002). In addition to the inappropriate use of inhalers, several other factors that can affect therapeutic outcomes are exacerbations of asthma and patient compliance in using asthma medications (Kebede, et al, 2019).…”