Assessment of inhaler using technique among adult asthma patients in Bangladesh: a facility-based cross-sectional study

Abstract

Abstract Background: Inhaler using technique has influences on disease control in patients with bronchial asthma. The objective of this study was to assess the inhaler using technique and factors associated with correct technique among adult asthma patients in northern Bangladesh.Methods: A total 357 asthma patients were recruited from medicine outpatient department of Rajshahi Medical College Hospital (RMCH) from November 2020 to January 2021. All patients were stable and using either metered dose inhaler (MDI) with or without spacer or dry powder inhaler (DPI). Demographic and disease details were collected by direct interviewing of the patients and inhaler using technique were also observed. A preformed checklist was used for marking the activities of the patients. Inhaler using technique was defined as incorrect if there was one or more critical error observed during using the prescribed inhaler. Logistic regression model was used to determine the predictors of incorrect inhaler using technique. Results: Almost 77% of the MDI users, 85% of the MDI with spacer users, and 76% of the DPI users had at least one or more critical error in handling their inhaler devices. Most commonly missed critical steps were breathing in adequately during inhalation (40% in MDI and 39% in DPI users) and holding breath after inhalation (54% in MDI and 77% in DPI users). Patients with lower educational attainment (aOR 4.56, 95% CI 1.13-18.37, p<0.05), middle-income family (aOR 6.44, 95% CI 1.73-24.03, p<0.01), self-reported difficulty of inhaler technique (aOR 3.18, 95% CI 1.58-6.41, p<0.01), seeking care from non-qualified practitioners (aOR 2.86, 95% CI 1.42-5.75, p<0.01) and no demonstration of inhaler technique (aOR 2.07, 95% CI 1.71-3.01, p<0.05) or demonstration from non-qualified practitioners (aOR 2.41, 95% CI 1.79-4.36, p<0.05) had higher chance of incorrect inhaler using technique.Conclusion: Majority of the asthma patients included in our study had one or more critical error in their inhaler using technique especially in patients with lack of inhaler using training. Patient counseling and demonstration of inhaler using technique during prescription might increase the proportion of patients practicing right technique of inhaler.