Comparison of Inhaler Technique between Dry Powder Inhalers and Metered Dose Inhalers among adults with Obstructive Airway Disease
Keywords:
Respiratory Diseases, Obstructive Airway Diseases, Inhaler, Inhaler techniquesAbstract
Background: Proper inhaler technique is crucial for effective management of obstructive airway diseases, yet many patients misuse it. Dry powder inhalers (DPI) and metered dose inhalers (MDI) require different handling skills, and errors in technique can lead to poor drug delivery and suboptimal disease control. Understanding the prevalence and types of errors can guide targeted patient education and improve outcomes. Objective: To assess and compare inhaler technique performance among adult patients using dry powder inhalers (DPI) and metered dose inhalers (MDI), and to determine the prevalence of specific technique errors along with associated patient-related factors. Methodology: This hospital-based cross-sectional study was conducted in the Department of Pulmonology, Mardan Medical Complex, Mardan from July 2023 to July 2024. Adult patients with asthma or COPD who had used DPI or MDI for at least 3 months were enrolled in this study. Results: A total of 180 patients (90 DPI, 90 MDI) with a mean age of 58.6 ± 12.4 years were included, of whom 54.4% were female. Inhaler technique errors were highly prevalent, observed in 91.1% of DPI users and 94.4% of MDI users before instruction. Age was significantly associated with errors among MDI users, with an 8% increase in error probability per year (OR 1.08; 95% CI: 1.03–1.14). Conclusion: Inhaler technique errors are highly prevalent among adults with obstructive airway disease using both DPI and MDI, with breathing-related and device-specific errors most common. Older age was associated with higher error rates in MDI users, highlighting the need for tailored interventions.References
Levy ML, Bacharier LB, Bateman E, Boulet LP, Brightling C, Buhl R, et al. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med. 2023;33(1):7. DOI: 10.1038/s41533-023-00330-1.
Lea S, Higham A, Beech A, Singh D. How inhaled corticosteroids target inflammation in COPD. Eur Respir Rev. 2023;32(170). DOI:10.1183/16000617.0084-2023.
Newman SP. Drug delivery to the lungs: challenges and opportunities. Ther Deliv. 2017;8(8):647-661. DOI: 10.4155/tde-2017-0037.
Lavorini F, Janson C, Braido F, Stratelis G, Løkke A. What to consider before prescribing inhaled medications: a pragmatic approach for evaluating the current inhaler landscape. Ther Adv Respir Dis. 2019;13:1753466619884532. DOI: 10.1177/1753466619884532.
Molimard M, Raherison C, Lignot S, Depont F, Abouelfath A, Moore N. Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care. J Aerosol Med. 2003;16(3):249-254. DOI: 10.1089/089426803769017613.
Usmani OS. Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag. 2019:461-72. DOI: 10.2147/TCRM.S160365.
Salvi S, Shevade M, Aggarwal A, Apte K, Barne M, Mohan MB, et al. A practical guide on the use of inhaler devices for asthma and COPD. J Assoc Physicians India. 2021;69:8-26.
Rodriguez?Garcia C, Barreiro E, Muñoz?Gall X, Bustamante?Madariaga V, de?Granda?Orive I, Gonzalez?Barcala FJ. Common errors in inhalation therapy: Impact and solutions. Clin Respir J. 2020;14(11):1001-10. DOI:10.1111/crj.13236.
Ahn JH, Chung JH, Shin KC, Jin HJ, Jang JG, Lee MS, et al. The effects of repeated inhaler device handling education in COPD patients: a prospective cohort study. Sci Rep. 2020;10(1):19676. DOI:10.1038/s41598-020-76961-y.
Sarwar KA, Naseer U, Tabassum A, Naseer F. Assessment of inhalational technique of Metered dose inhalers (pMDIs) among its users. Pak J Chest Med. 2020;26(1):15-21.
Usmani OS, Lavorini F, Marshall J, Dunlop WCN, Heron L, Farrington E, et al. Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes. Respir Res. 2018;19(1):10. DOI:10.1186/s12931-017-0710-y.
Sanchis J, Gich I, Pedersen S, Aerosol Drug Management Improvement Team (ADMIT). Systematic review of errors in inhaler use. Chest. 2016;150(2):394-406. DOI: 10.1016/j.chest.2016.03.041.
Dalal S, Shamaliya K, Patni A. Assessment of inhalational techniques and their common errors in bronchial asthma patients coming to tertiary hospital of South Gujarat. Indian J Respir Care. 2020;9(2):204.
Harb HS, Laz NI, Rabea H, Abdelrahim ME. First-time handling of different inhalers by chronic obstructive lung disease patients. Exp Lung Res. 2020;46(7):258-69. DOI: 10.1080/01902148.2020.1789903.
Scullion J. Teaching inhaler technique. J Prescr Pract. 2020;2(5):234-7. DOI:10.12968/jprp.2020.2.5.234.
Bosnic-Anticevich S, Bender BG, Shuler MT, Hess M, Kocks JWH. Inhaler technique decay. J Allergy Clin Immunol Pract. 2023;11(8):2355-2364.
DOI: 10.1016/j.jaip.2023.04.031.
Bartziokas K, Papaporfyriou A, Hillas G, Papaioannou AI, Loukides S. Global initiative for chronic obstructive lung disease (GOLD) recommendations: strengths and concerns for future needs. Postgrad Med. 2023;135(4):327-33. DOI: 10.1080/00325481.2022.2135893.
Sorino C, Negri S, Spanevello A, Visca D, Scichilone N. Inhalation therapy devices for the treatment of obstructive lung diseases: the history of inhalers towards the ideal inhaler. Eur J Intern Med. 2020;75:15-8. DOI:10.1016/j.ejim.2020.02.023.
Navaie M, Dembek C, Cho-Reyes S, Yeh K, Celli BR. Device use errors with soft mist inhalers: a global systematic literature review and meta-analysis. Chron Respir Dis. 2020;17:1479973119901234. DOI:10.1177/1479973119901234.
Price DB, Román-Rodríguez M, McQueen RB, Bosnic-Anticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract. 2017;5(4):1071-81. DOI:10.1016/j.jaip.2017.01.004.
Usmani OS. Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag. 2019:461-72. DOI:10.2147/TCRM.S160365.
Lee HY, Song JH, Won HK, Park YS, Sohn KH, Kim TB, et al. Inhaler technique in elderly patients. Tuberc Respir Dis (Seoul). 2021;84(1):46-54.
DOI: 10.4046/trd.2020.0021
AL-awaisheh RA, Alsayed AR, Basheti IA. Assessing the pharmacist’s role in counseling asthmatic adults using the correct inhaler technique and its effect on asthma control, adherence, and quality of life. Patient Prefer Adherence. 2023:961-72.
Kim YM, Yu M, Moon HR, Ju SY, Lee GA, Kim MJ. Effects of a tailored inhaler use education program for chronic obstructive pulmonary disease patients. Patient Educ Couns. 2020;103(4):717-23. DOI:10.1016/j.pec.2020.02
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Chest Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
