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14-03-2013 | Respiratory | Article

Poor inhaler technique linked to poor asthma control, ED visits


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medwireNews: Asthma patients with improper inhaler technique are more likely to have poor disease control and a higher frequency of hospital emergency department (ED) visits than those with good technique, results from a Saudi Arabian study show.

The study of 450 adult asthma patients also revealed that the main cause of improper inhaler technique was likely to be a lack of appropriate asthma education.

"National asthma studies are necessary to explore this problem and to prospectively study the value of an interventional asthma education program to improve asthma inhaler device use and clinical treatment outcomes," comment Hamdan Al-Jahdali (King Saud bin Abdulaziz University for Health Sciences, Riyadh) and colleagues.

All of the patients (39.1% men) had visited an ED with bronchial asthma attacks over a 9-month period and were assessed for inhaler technique using a checklist.

The patients, who had a mean age of 42.3 years and had been taking prescribed inhaled corticosteroids (ICSs) for at least 3 months, were also assessed for demographic characteristics and disease management.

Overall, 45% of the patients demonstrated improper use of their inhaler devices. Furthermore, 51.6% had no asthma education by any health care professional and 40.7% had no education about asthma medications.

The team found that patients with irregular clinic visits were more likely to misuse their inhaler device than those with regular visits (60.9 vs 34.8%), as were those with versus without asthma medication education (54.6 vs 38.7%), and those with three or more ED visits due to asthma exacerbations versus those with fewer visits (50.9 vs 41.3%).

Patients with uncontrolled asthma (Asthma Control Test [ACT] score ≤15) were also more likely to misuse their inhaler devices than those with partially/fully controlled asthma (ACT score >15), at 59.1% versus 40.8%.

Multiple logistic regression analysis revealed that factors significantly associated with improper use of inhaler devices included an ACT score of 15 or less (odds ratio [OR]=7.41), irregular use of ICSs (OR=2.37), a lack of asthma education (OR=1.65), and a lack of clinical follow up (OR=1.73).

Al-Jahdali et al conclude in Allergy, Asthma and Clinical Immunology: "Almost half of our patients used asthma devices improperly, resulting in more visits to the ED due to subsequently poor asthma control."

They add: "The lack of appropriate asthma education is likely a major cause of improper device use."

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

By Mark Cowen, Senior medwireNews Reporter

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