Use of inhaler device in patients with asthma or chronic obstructive pulmonary disease: Errors and adherence problems

Inhaled therapy is a mainstay in the management of asthma and chronic obstructive pulmonary disease (COPD). Metered dose inhaler (MDI), dry powder inhaler (DPI) and MDI with spacer are the most commonly used. Errors in inhaler techniques are very common in asthma and COPD patients. Poor inhaler technique brings about inadequate drug delivery to respiratory system leading to poor disease control.

The study aims at identifying different types of inhalers used and to evaluate the errors and non-adherence in their use. Also, to rectify errors and to improve adherence by education through patient information leaflet (PIL).

The study was conducted in three phases. Errors were evaluated using self-administered questionnaire and adherence were evaluated using drug attitude inventory in phase 1. Leaflets were provided to patients, to minimize errors and educate patients to improve adherence in phase 2. The entire data were analysed using different statistical method in phase 3.

Out of 100 patients, 58% of them were asthma patients (n=58) and 42% of them were COPD patients (n=42). Among 87 patients using MDI and MDI with spacer, 21 patients performed all the steps correctly. Peak non-adherence was seen in age group >60 years (25%). While comparing adherence status of various age group the patients >60 years (39%) shows more adherence. It implies that non adherence and adherence are seen maximum in the age group of greater than 60 since population density was seen more in this category. The study was statistically significant (p value of 0.027).

The study emphasises the role of clinical pharmacist in identifying and minimizing errors through patient information leaflet. The evaluation of adherence was also carried out and categorized patients into adherent and non-adherent category. The adherence was increased through patient education.