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12-05-2011 | Immunology | Article

Poor inhaler technique common in asthma, COPD patients


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MedWire News: Improper inhaler technique is common among patients with asthma and chronic obstructive pulmonary disease (COPD) and is associated with poor disease control and unscheduled use of health-care resources, Italian research shows.

The correct use of metered dose inhalers (MDIs) and dry powder inhalers (DPIs) is crucial for the effective management of asthma and COPD, observe Andrea Melani (Azienda Ospedaliera Senese, Siena) and team.

But they add previous studies have suggested that many patients have poor inhalation technique.

To investigate further, the team studied 1664 adult patients, aged an average of 62 years, who were attending 24 chest clinics in Italy. Most of the patients had COPD (52%) or asthma (42%) and were regularly using MDIs (n=843) and DPIs (n=1113) at home. Regular inhaler use was defined as at least once daily for 4 weeks in the 3 months prior to enrolment.

Each patient was asked to demonstrate their inhalation technique to a trained investigator using a placebo device during at least one scheduled clinic visit, resulting in 2288 records of inhaler technique.

They also supplied demographic information and completed questionnaires detailing unscheduled medical interventions due to their respiratory disease, such as visits to an emergency room, hospital admissions, use of antimicrobial treatments, and courses of oral corticosteroids during the past year.

In addition, disease control was assessed in both asthmatic and nonasthmatic individuals using the asthma control test (ACT).

The researchers found that serious mistakes in inhaler use were common, ranging from 12% to 44% dependent on the type of inhaler used.

Independently of inhaler type, poor inhaler technique was significantly associated with older age, lower educational attainment, and lack of instruction by healthcare givers.

Furthermore, improper inhaler use was significantly associated with increased risk for hospital admission (odds ratio [OR]=1.47) and emergency room visits (OR=1.62), and use of oral steroids (OR= 1.54) and antimicrobials (OR= 1.50) in the past year.

Poor inhaler technique was also associated with reduced disease control in asthmatics and the whole population.

Melani and team conclude: "This study shows that mishandling of inhaler technique remains common in real life for both MDIs and DPIs and is associated with poor clinical control and increased unscheduled health-care resources in asthma and COPD patients."

They add: "Further prospective studies are needed to assess the value of educational interventions in patients showing poor inhalation technique and whether improvements in inhalation technique might be related to better disease control and clinical outcomes."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Mark Cowen

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