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22-12-2013 | Respiratory | Article

Older age linked to poor inhaler technique


Free abstract

medwireNews: Poor metered dose inhaler (MDI) technique is common among older patients with asthma and is associated with reduced controller medication adherence, prospective study findings show.


Juan Wisnivesky (Mount Sinai School of Medicine, New York, USA) and colleagues found higher levels of nonadherence in patients who were not using their inhaler correctly.

The researchers studied a cohort of 326 patients with asthma aged a mean of 48 years and of whom the majority was of Hispanic (55%) or Black (27%) ethnicity, linking the distribution of missed MDI technique steps to adherence, assessed via the Medication Adherence Report Scale.

MDI technique was assessed via a standardized checklist that included eight key steps from shaking the inhaler and removing the protective cap to taking the inhaler out of the mouth after inhaling and holding the breath for 5–10 seconds.


Overall, just 16% of patients achieved a perfect MDI technique score, 40% missed 1–2 steps, 34% 3–4 steps, and 12% missed 5–6 steps. Adherence rates were significantly higher, at 62%, in patients with perfect MDI technique than in those who missed 1–2 (48%), 3–4 (39%), or 5–6 (20%) of the recommended steps.


“[W]e did not find associations between income level or years of education and MDI technique,” the researchers report in the Clinical Respiratory Journal. However, most (64%) of the study participants had a low annual income and one-third had not graduated from high school, so perhaps there was not enough variability in the study population to show an effect, they suggest.

Younger age (<55 years) was significantly associated with MDI technique, with older patients less likely to be using their inhaler correctly. This warrants further investigation, the researchers say.

“Future studies should explore the age-related factors associated with improper MDI use, and subsequently evaluate interventions to promote MDI use among older asthmatics.”

Wisnivesky et al conclude: “Assessment of MDI technique may be a simple clinical aid to identify patients with low adherence to controller medications.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Sara Freeman, medwireNews Reporter

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