Associations between inhaler technique and asthma control among asthma patients using pressurised MDIs and DPIs

To investigate associations between technique with pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) used as controller medication and asthma control variables measured using Asthma Control Test (ACT) scores.

In this cross-sectional study, the inhaler technique of asthma patients using pMDIs or DPIs (Turbuhaler® [TH] and Accuhaler Diskus™ [ACC]) were assessed against published inhaler technique checklists. ACT scores (maximum 25, higher score corresponding to better asthma control) were assessed.

Of the 130 subjects enrolled in the study (41 TH, 54 ACC and 35 pMDI), inhaler technique scores (out of nine for all devices) were low for TH (4.4 ± 0.9) and ACC (5.4 ± 1.0) compared with pMDI (8.1 ± 0.9) (P < 0.001, one-way analysis of variance). Older age and use of pMDI were associated with better inhaler technique. ACT scores were low, consistent with very poorly controlled asthma (mean TH 13.1 ± SD 3.9, mean ACC 13.3 ± SD 3.9 and mean pMDI 12.8 ± SD 4.2). No significant association between inhaler technique scores and ACT scores was found. More recent asthma diagnosis and a higher level of education were associated with higher ACT scores (better asthma control).

Asthma control was poor in this population. Lack of a significant association between the inhaler technique score and asthma control may reflect the multiple factors contributing to poor asthma control in the Jordanian population.