Predictors of good inhaler technique in asthma and COPD

Abstract

Intro: The use of inhalers or other devices is dependent on proper technique.

Aim: To evaluate Asthma and COPD patients and determine factors that predict proper inhaler use.

Methods: 167 patients (Male 45%, Mean age 57.6, std 15.3 years) were recruited both from hospital outpatients and from the community. Patients had to be on regular inhalers. 41.3% were under the care of a respiratory physician, 25.7% GP, 19.8% both, and 13.2% none. A questionnaire was filled by the patient followed by direct observation of inhaler technique.

Results: Self-rating of inhaler technique 0-10 mean 7.91, sd 2.06, with 80.1% >=7/10. 67.7% said use of inhaler was easy or very easy, 93.4% said inhalers were effective or very effective. 164 patients used MDIs, of which 119 utilized a spacer. 32(19.2%) used formoterol aerolizer, and 8 (4.8%) used a turbohaler. MDI use was analysed in 12 steps, and 13 with spacer. Mean score was 82.9% (95%CI 80.7-85.1). Paired T test and Mann whitney test comparing with self rating (p=0.45,0.24). Spearman Correlation p=-0.021. Predictors for score >=80%: demo by other health worker OR 4.39(1.62-11.94,p=0.002), Male Gender 4.13(1.75-9.8 p=0.0001), Influenza vaccine ever 3.7(1.17-11.8, p=0.023), Education level 1-4 1.79(1.15-2.77, p=0.006), number of times explained by doctor 0-4 1.43(1.0-2.47, p=0.048), years of use in decades 1.29(0.98-1.67,p=0.058), self-score 1-10 1.28(1.05-1.56, p=0.012), Use of reliever 0-4 0.74(0.56-0.99, p=0.041), Heart disease 0.25(0.09-0.75, p=0.011).

Conclusion: Patients' self-rating, repeated physician demos, health professional demos, longer duration of use, education level and male gender and lower reliever use predicted good technique in a group with high percentage of good technique.