The determinants of incorrect inhaler use in patients with obstructive airway disease

Inhaler therapy is the standard treatment for obstructive airway disease. Even in today's world, it is very challenging to utilize this therapy optimally. Errors in inhaler technique are very common. Identifying the errors is the first step towards correction to improve the disease. This is a cross-sectional observational study conducted at AIMS, Mohali, where 212 patients on inhaler therapy were enrolled who were diagnosed with asthma or chronic obstructive pulmonary disease or post-tuberculosis lung disease. The inhaler technique was assessed by a 5-point inhaler technique checklist by the clinician during the OPD visit. A multivariate binomial regression analysis was performed to calculate the crude and adjusted odds ratio of at least 1 error in inhalation technique and other covariates, including age, gender, education, profession, device, duration, and diagnosis. Among 212 enrolled patients, 135 adults (18-60 yrs) and 77 elderly (>60 years) were analyzed. Elderly [p<0.001; adjusted odds ratio (AOR) 8.12], unemployed (p=0.016), more than 5 years of inhaler use (p=0.005; AOR 9.54) and metered dose inhaler (p<0.001; AOR 5.86) had more chances of committing at least 1 error in inhaler technique. Identifying and correcting the errors in inhalational technique is the easiest and cost effective method to decrease the exacerbations and improve disease control in patients suffering from OAD by further decreasing the healthcare burden.