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

Abstract

Objectives: Asthma and chronic obstructive pulmonary disease (COPD) are chronic illnesses of the airways affecting a good number of people in Lebanon and the Middle East. Pressurized metered-dose inhalers (pMDIs) are important drug delivery systems used to treat such pulmonary diseases. Drugs proven to be valuable and effective may fail to act effectively if such inhalers are used incorrectly. The purpose of this study was to assess the technical use of pMDIs by patients with pulmonary diseases presenting to the community pharmacies in Lebanon. Methods: A structured questionnaire was developed to collect data. A total of 601 patients using drugs delivered through pMDIs and presenting to 12 Lebanese community pharmacies were recruited to participate in the research project. The questionnaire items were divided into 3 subscales: subscale 1—assessing the device preparation; subscale 2—investigating the device use; and subscale 3—examining the knowledge and use of spacers. After confirming the reliability and validity of the survey tool, patients’ responses were analyzed and compared according to many variables. Results: Many patients answered inaccurately to questions assessing both the device preparation and use. Around 40% of patients said they do not coordinate the inhalation with pressing the canister down. The mean scores were 1.72 (± 0.73) over 6 and 5.67 (± 1.44) over 7 for subscales 1 and 2, respectively. The mean total score on all questions was 7.39 over 13, with a standard deviation of 1.75. While patients’ age did not impact the results, asthmatic, well-educated, male patients had fewer wrong answers when it comes to preparing and using the device ( P < .01). Conclusions: Our study showed that many patients with asthma and COPD might not be properly using their pMDIs. Appropriate inhaler use is crucial for successful pulmonary disease management. As pMDIs are one of the most difficult devices to use, proper and tailored instructions should be given to patients.

Predictors of proper inhaler technique and asthma control in pediatric patients with asthma

“…Previous studies among adults mainly highlighted different factors contributing to proper inhaler technique such age, 6 gender, 7,8 education level, 7,8 using more than one inhaler, 9 receiving instructions on inhalation, 9 using metered dose inhaler (MDI), 4,6 comorbidity, 4,7 monthly income, 4 and awareness of steroid use 7 . The old study that assessed factors of proper inhaler technique among children had reported that repetition of instructions regarding inhaler use was the main determinant for correct inhaler technique 10 .…”

“…It is also greatly affected by proper home management by parents and caregivers 11 . Only few studies have assessed the inhaler technique and its predictors among children with asthma worldwide 4,5,8,10 . Importantly, these studies were limited by their small sample size, their inclusion of other respiratory diseases, and combined population (adults and children).…”

Could Arachidonic Acid-Derived Pro-Resolving Mediators Be a New Therapeutic Strategy for Asthma Therapy?

“…Asthma is a high prevalence chronic inflammatory pulmonary disease, the respiratory symptoms of which include cough, wheezing, shortness of breath, and chest tightness which leads to elevated morbidity, mortality, and disease social and economic costs (1)(2)(3). Pulmonary inflammation is the hallmark of asthma, which is driven by a Th2 immune reponse to inhaled allergens, and associated with infiltration of the bronchial mucosa with eosinophils, CD4+ T cells, macrophages and, in exacerbations and severe cases, neutrophils (4,5).…”

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

“…Study found that the combination of salmeterol and fluticasone provided a significant improvement in lung mechanics in COPD patients (Chen, et al, 2016). Propriety use of MDI in asthma patients is assessed using a validated questionnaire developed by Ramadan, et al (2020). The questionnaire consists of 2 subscales with 11 questions in total.…”

“…The research instrument is a valid questionnaire to measure the proper use of MDI developed by Ramadan, et al (2020) and the Asthma Control Test (ACT) questionnaire, a standard questionnaire to measure the level of asthma control (Nathan, et al, 2004). Univariate analysis was performed to describe patients' characteristics such as age, gender, smoking habits, asthma severity, and medications used.…”