Barriers to and competency with the use of metered dose inhaler and its impact on disease control among adult asthmatic patients in Ethiopia

Abstract

Background: Asthma is one of the chronic diseases which affects the airway, and inhalers are the preferred medications to treat this problem. Improper inhalational technique leads to decreased efficacy of the medication by reducing its deposition in the lungs. The aim of this study was to assess the barriers to and competency with the use of Metered Dose Inhaler (MDI) and its impact on disease control among adult asthmatic patients. Methods: A prospective cross-sectional study was conducted in University of Gondar comprehensive specialized hospital outpatient department (OPD) chronic follow up from 12-March-2018 to 15-May-2018. Patients were interviewed face to face with questions which determined their competency, asthma control level and barriers for inhaler use. Result: Overall, 307 asthmatic patients were included in the study. More than half of participants were females, 170 (55.4%) and lived in urban area 185 (60.3%). The mean age of the respondents was 51.77 years with a standard deviation of ±15.40. The cost of medication, 282 (91.9%) and the perception that medication should be used in response to symptoms but not on a regular basis 277 (90.2%) were the most identified barriers. Only 56 (18.2%) were competent for Metered Dose Inhaler use (MDIU) and 17 (5.5%) patients had well controlled asthma. Being not competent AOR 0.168[0.41-0.687] was one of the factors decreasing asthma control. Conclusion: Generally from this study, cost of the medication and the perception that medication should be used only for symptoms were the major identified barriers that affect the MDI use among asthmatic patients. Patients show very poor competence to their MDI which in turn led to poor asthma control. So, patients need to be taught the correct inhaler technique in the hospital and pharmacy while they came for follow up every time.

A Study on Effectiveness and Outcomes of Educational Inhaler Technique Counselling in Respiratory Department by Clinical Pharmacist

“…So, proper technique improves disease outcomes and the quality of life of patients. 9,10 There are two widely used methods to provide structured education regarding inhaler use-one, to bestow the actual physical demonstration of the device and provide printed material/flyer enunciating the pictures or text explaining the method of inhaler use. We carried out this study by providing a physical demonstration of the device to the patients.…”

Asthma control and its predictors in Ethiopia: Systematic review and meta-analysis

“…Uncontrolled asthma was defined as the presence of any three or more of these individual features within any week. According to the standardized self-administered ACT [ 6 , 17 ], asthma control was classified as not well-controlled and well-controlled. Patients were classified as not well-controlled when the overall ACT score is less than or 19 and well-controlled when the overall ACT score is above 20.…”

Global burden of medication non-adherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers

“…For example, patients with COPD have an adherence rate of only 22% in South-Korea, 29.2% in China, 34.8% in Italy, 23.9% in Belgium, 32.4% in Spain, 25% in Canada, 23.4% in the United States (US) and 27.4% in Nigeria (Figure 1) (9,(15)(16)(17)(18)(19)(20)(21). Except for Brazil and Italy, with an adherence rate of 52% and 43.8% among patients with asthma, respectively, the adherence rate of patients with asthma is not much better: patients with asthma in US are for 22.2% adherent, in France for 24.9%, in Ethiopia for 18%, in Saudi-Arabia for 27.4%, in China for 13.8%, in Australia for 19.4% and in New-Zealand for only 30% (Figure 1) (22)(23)(24)(25)(26)(27)(28)(29)(30). While true differences in patient adherence between countries could actually exist, it should be acknowledged that also the definitions of adherence or the adherence measurement methods contribute to variation.…”

“…The first can be intentional or unintentional; the latter is usually unintentional, patients do inhale their medication, but not correctly (11). Research shows that only 18.2% of the patients with asthma was able to perform more than seven of the eleven inhalation steps correctly (24).…”

“…Inhalation technique affects adherence via the second phase of adherence: implementation. The most frequently occurring inhalation errors are an insufficient inspiratory flow, not exhaling before inhaling the medication, absence of breath hold after inhaling the medication and unsuccessful dose preparation (8,24,31). Up to 94% of the dry powder inhaler (DPI) users, both patients with asthma/COPD, make at least one inhaler error during each inhalation that results in suboptimal treatment (3,32).…”