IMPACT OF IMPROPER INHALER USE IN ASTHMA AND COPD PATIENTS

Abstract

Background: Asthma and chronic obstructive pulmonary disease (COPD) were prevalent chronic respiratory conditions that required long-term inhaled pharmacotherapy for optimal management. Various inhaler devices, included pressurized metered-dose inhalers (pMDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs), were widely used. However, improper inhaler technique remained a significant global issue. Common critical errors such as poor hand–breath coordination, inadequate inspiratory flow, and incorrect device positioning reduce effective pulmonary drug deposition. These errors contributed to poor disease control, persistent symptoms, increased exacerbation rates, frequent emergency visits, avoidable hospitalizations, and increased healthcare burden. International guidelines such as GINA and GOLD emphasized the importance of regular inhaler technique assessment, proper training, and individualized device selection.

Objective(s): To assess the prevalence of improper inhaler technique among asthma and COPD patients in local clinical settings and to evaluate its association with symptom severity, frequency of exacerbations, and hospital admissions. Additionally, the study aimed to identify patient-related barriers and support the development of targeted educational interventions.

Methodology: A cross-sectional study was conducted involving 70 patients diagnosed with asthma and COPD who were using inhaled medications. Data was collected using structured questionnaires and clinical assessments, including patient demographics, inhaler technique, medication adherence, symptom control, exacerbation frequency, and healthcare utilization. Inhaler technique was evaluated using standardized device-specific checklists. Statistical analysis was performed to determine the association between improper inhaler use and clinical outcomes.

Results: The total of 70 patients participated, the mean and standard deviation of age was 66.07±14.334. The minimum age was 31 and maximum age was 95. The male patients were 41(58.6%) and female were 29(41.4%). The total 24(34.3%) patients have respiratory disease from more than 10 years. Out of 70 patients, 39(55.7%) have asthma and 29(41.4%) have COPD. The total of 40(57.1%) patients currently use an inhaler and 41(58.6%) patients use MDI type of inhaler in which 30(42.9%) patients use inhaler as prescribed. 55./% patients don't know the correct steps to use inhaler, 47.1% patients were not use to shake MDI tape inhaler before use and 51.4% patients never fully exhale before using inhaler, 34.3% were not sure to hold breath after using inhaler, and 51.4% never rinse their mouth after inhaler use. 82.9% patients skip their inhaler dose, 47.1% patients experience worsening of symptoms monthly in which 61.4% visit hospital every month. The total of 77.1% patients have poorly controlled asthma and 55.7 patients have low COPD assessment test score. The crosstabulation between ACT and CAT with shaking the inhaler before use, exhale fully before using inhaler and rinsing mouth after inhaler use shows a statistically significant association with the p-value of (0.035), )0.008), (0.003) and (0.004), (0.001), (0.015) respectively.

Conclusion(s): Improper inhaler technique was expected to be a major contributing factor to poor disease outcomes in asthma and COPD patients. Routine assessment, patient education, and personalized inhaler selection were essential strategies to improve treatment effectiveness and reduce disease burden.