Page 51 - IJSA, Vol. 6, No 1, 2023

International Journal of Science Annals, Vol. 6, No. 1, 2023
рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa

Using inhalers without imparting adequate education suspected pregnancy, breastfeeding, allergy, sensitivity
regarding proper technique of their usage may result in or intolerance to asthma or COPD therapy, and being on
suboptimal clinical improvement and wastage of nebulizer therapy were the exclusion criteria of the
medication. study.
We evaluated the technique of patients using manually Demographic details of patients, type and duration of
operated inhaler devices, metered dose inhaler and dry inhaler therapy, and assessment of inhaler technique
powder inhalers to study the association of poor inhaler (correct, incorrect) were recorded.
technique with patient demographics and other Inhaler technique was assessed using a protocol
variables. described by Melani (2007). This protocol documents
The aim of the study. To study the association of errors the performance of ten essential inhaler technique steps
in the technique for using two types of inhalers with by means of closed dichotomous response options (well
demographic and other variables. performed/poorly performed). All assessments were
made by two investigators with ten years of experience
Materials and Methods in the follow-up of asthma patients. After assessment, all
A total of 500 adult patients with respiratory diseases patients were given supplemental instruction on inhaler
who were currently using at least one inhaler device for technique by a health professional, in the form of a
at least 1 month were included in this cross-sectional, demonstration.
observational study conducted at Department of
Tuberculosis and Chest Diseases, in a tertiary care Results
hospital of North India. Out of 500 enrolled patients, 465 patients were using the
Most commonly used devices metered dose inhaler and device with wrong technique. Out of these 465 patients,
dry powder inhalers were assessed in this study. 188 were using metered dose inhaler (Table 1) and 277
Use of inhaler therapy for less than a month, lack of were using dry powder inhaler (Table 2).
attendance of regular control visits, confirmed or

Table 1
Errors in Inhalation Technique with Metered Dose Inhaler (n=188)

Number of patients who made errors
Inhalation technique
people percentage
Take off the inhaler cap 16 8.5
Shake the metered dose inhaler before use 79 42.0
Hold the metered dose inhaler in a vertical position 47 25.0
Hold your head in a vertical position 53 28.1
Exhale before use 129 68.6
Put the mouthpiece in your mouth, and close your lips 33 17.5
Press the canister when inhaling slowly 126 67.0
Inhale deeply 91 48.4
Hold your breath for 10 seconds 71 37.7
Exhale and wait for 30-60 seconds before the other puff 32 14.3

Table 2
Errors in Inhalation Technique with Dry Powder Inhaler (n=277)

Number of patients who made errors
Inhalation technique
people percentage
Pull off the aerolizer cover 19 6.8
Open the mouthpiece of dry powder inhaler 16 5.7
Remove the capsule from the package and put it into the space 47 16.9
Press the buttons on both sides of dry powder inhaler 79 28.5
Hold your head in a vertical position 61 22.0
Turn your head away from dry powder inhaler and exhale 198 71.4
Put the mouthpiece in your mouth, and close your lips 26 9.3
Inhale deeply 119 42.9
Hold your breath for 10 seconds 97 35.0
Dispose of the capsule and put the cover back on the dry powder inhaler 36 12.9

Each step of metered dose inhaler use is observed and (48.4%) did not inhale deeply after pressing canister.
documented. Out of 188, 129 patients (68.6%) did not 79 patients (42.0%) did not shake the inhaler before use,
exhale before inhaler use, 126 patients (67.0%) failed to 71 patients (37.7%) did not hold their breath for 10
press the canister while inhaling slowly, and 91 patients seconds, 47 patients (25.0%) failed to hold the inhaler in

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