Evaluating the technique of using inhalation device (MDI) without holding chamber/spacer in asthma and Chronic Obstructive Pulmonary Disease

Abstract

Background: Both asthma and Chronic Obstructive Pulmonary Disease(COPD) are best treated with the use of aerosolized drugs delivered directly into the airways via various devices. The most commonly used device still is a press and breath Metered Dose Inhalors (MDI). Most people find it difficult to carry a holding chamber/spacer and usually prefer to use MDI without it. Although MDIs are cheap and their use is simple, the users need to understand and practice the various simple steps properly for optimal drug delivery. Suboptimal use of the device may result in poor drug delivery into the airway, increased inhaler use, decreased bronchodilation, reduced patient's adherence to the treatment regimen and poor disease control.Objective: The objective of this study was to evaluate and analyse inhalation technique used by patients with asthma andCOPDin a tertiary care center.Methodology: This study was carried out at the out-patient department of the chest unit at Liaquat National Hospital, Karachi, Pakistan between June 2017 and November 2017. Two hundred consecutive patients using MDIs were requested to demonstrate their inhaler technique. Patients' MDI inhaler technique was recorded against standardized twelve step checklist and analyzed.Results: Of the total 200 enrolled participants, 136 (74%) had erroneous MDI use technique. Of those with sub-optimal technique, majority (77%) failed to demonstrate breathing in slowly filling lung with medication following actuation of MDI.68% were unable to demonstrate ability to hold breath for 10 seconds or as per their tolerance.64% failed to take a break for 30-60 second before next actuation. Other less common errors included not breathing out fully before holding MDI in mouth, failure to shake inhaler up and down before use and inappropriate pressing of canister for actuation.Conclusion: Majority of the patients using MDI devices (without holdingchamber/ spacer) make errors while using the device compromising drugdelivery in airways. When prescribing MDIs, proper training in its use must be ensured.