Page 52 - 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

vertical position, while 53 patients (28.1%) failed to ability of hand-lung coordination and is therefore
hold their head in vertical position. 33 patients (17.5%) considered inherently more difficult to use than dry
forgot to close their lips after putting mouthpiece in powder inhalers (Pothirat et al., 2015; Rootmensen et
mouth, 32 patients (14.3%) did not wait before for 30- al., 2010).
60 seconds before next inhalation, 16 patients (8.5%) Therefore, errors related to device handling were
did not take off the inhaler cap. common among metered dose inhaler users than among
The most common error while using dry powder inhaler dry powder inhalers users. Failure to exhale before using
is patient did not exhale before using inhaler like the metered dose inhaler is the most common error,
metered dose inhaler users. Out of 277, 198 patients followed by lack of coordination and failure to inhale
(71.4%) did not exhale before the use of inhaler, 119 deeply.
patients (42.9%) fail to inhale deeply, and 97 patients In dry powder, inhaler users the most common error is
(35.0%) did not hold the breath for 10 seconds. The most to exhale before using dry powder inhalers, followed by
uncommon error was, not removing cap of inhaler like failure to inhale deeply and failure to hold breath for 10
in metered dose inhaler users. seconds.
It was observed dry powder inhalers is the most These errors are more common with female gender as
commonly used device as shown by other studies study shows that the errors in using the inhaler devices
(Castel-Branco et al., 2017; Chorao et al., 2014; Melani both metered dose inhaler and dry powder inhalers are
et al., 2011). Poor inhaler technique and device handling more common in females. These errors are reduced with
is common in both metered dose inhaler and dry powder increasing duration of therapy and regular training.
inhalers users. That metered dose inhalers require a good (Table 3).

Table 3
Correlation of Errors with Various Parameters
Age of patient Gender of patients Duration of therapy Regular training on
Parameters
(Mean, years) Male Female (Mean, years) every visit
Take off the inhaler cap
Incorrect use 61 11.9 88.1 1.2 7.9
Correct use 54 59.1 38.9 5.8 68.9
P-value >0.001 <0.001 <0.001 <0.001
Hold the metered dose inhaler in a vertical position
Incorrect use 65 27.8 72.2 1.8 9.1
Correct use 52 36.3 63.7 6.1 79.6
P-value >0.001 <0.001 <0.001 <0.001
Hold your head in a vertical position
Incorrect use 62 20.4 79.6 2.1 6.7
Correct use 56 32.7 57.3 7.3 76.9
P-value >0.005 <0.001 <0.001 <0.001

Reduction in the numbers of errors is seen with increase forced expiration” (46=61.3%) and “no 10 second apnea
in the duration of therapy and regular training on follow- after inhalation” (51=68.0%); in the 16p metered dose
up visits. inhalers techniques common errors were “lack of hand-
lung coordination” (7=43.8%), “no previous forced
Discussion exhalation” (8=50.0%), and “no apnea after inhalation”
Not many researches have been conducted in India to (10=62.5%). This is similar to observations made in our
study the errors in inhalation techniques of metered dose study.
inhaler and dry powder inhalers users. In another study conducted by Melani et al. (2011), the
It was observed that inhaler technique errors are very errors in technique of inhalation was evaluated in trained
common and regular training can significantly reduce the patient. Independently of the inhaler, they found a strong
disease burden. Errors were more common with dry association between inhaler misuse and older age
powder inhalers than with metered dose inhaler. (p=0.008), lower schooling (p=0.001) and lack of
Although, the study done by Nainwal et al. (2022), DPI instruction received for inhaler technique by health
are considered, more advanced and more advantageous caregivers (p<0.001). Inhaler misuse was associated with
due to its stability and ability to deliver a high dose of the increased risk of hospitalization (p=0.001), emergency
drug to the lungs. Inability to exhale properly before use room visits (p<0.001), courses of oral steroids (p<0.001)
is the most common error followed by error in shaking and antimicrobials (p<0.001) and poor disease control
the device before use. evaluated as an Asthma Control Test (ACT) score for the
Similar results were observed in other studies. In a study asthmatics (p<0.0001) and the whole population
conducted by Castel-Branco et al. (2017), similar results (p<0.0001). This was similar to our study, where we
were obtained. The study involved 67 patients from four observed older age and lesser training was associated
community pharmacies. In the dry powder inhalers with more errors in inhalation technique.
techniques, the most frequent errors were “no previous

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