Impact of Educational Programme on Inhalational Device Usage Techniques among the Patients Suffering from Asthma

Abstract

Introduction: Aerosol inhalation is a mode of drug administration used in the management of asthma. Improper inhaler device usage techniques can lead to suboptimal therapeautic effect. Patients are very often prescribed inhaler devices without proper instructions regarding the correct usage technique, as the provider themselves may not be aware of the same. Aim: To compare the techniques of inhalational devices usage before and after training the patients suffering from asthma. Materials and Methods: An institution-based, prospective study was conducted among asthmatics reporting to the Department of Pulmonary Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, India, from March 2020 to September 2020. A total of 249 asthmatic patients who met diagnostic criteria recommended by Global Initiative for Asthma (GINA), who were on inhaler devices namely: pressurised Meter Dose Inhaler (pMDI), pMDI with spacer, Rotahaler®, and Revolizer®, and who consented to be part of the study were included in the present study. Each patient was advised to use the inhaler medication, during which the patient was observed, and the checklist was scored. Subsequently patients were educated regarding the correct, device specific usage technique with demonstration. After one month (post- training visit), using the same checklist, each patient was re- evaluated. For each correct step, the patient received a score of “one”, whereas, each incorrect step, as well as “no-response” was valued as “zero”. The sum of the scores for all the steps was calculated for each patient and each type of inhaler. The Microsoft Excel 2010 spreadsheet was used to enter the data. Descriptive statistics were represented using percentages, frequencies, graphs and in the form of tables. Mean difference was used to compare the scores before and after the training. A p-value<0.05 was considered statistically significant. The scores were categorised into “handling errors” and “inhalational errors”, percentage of participants committing at least one error, handling and inhalational error was tabulated. Results: Prior to the training, none of the subjects using pMDI and pMDI with spacer were able to complete all the steps appropriately. Whereas 7.8% of patients (4/51) using Rotahaler®, 4.5% of patients (2/44) using Revolizer® were able to perform all the steps accurately. During post-training follow- up, 59.22% (61/103) and 39.22% (20/51) patients using pMDI and pMDI with spacer, respectively, were able to perform all the steps accurately. Whereas 50.98% (26/51) and 72.73% (32/44) patients using Rotahaler® and Revolizer®, respectively, were able to perform all the steps accurately. Conclusion: The majority of asthmatics erred while utilising the inhaler devices. Errors were committed both during handling and inhalational steps. When trained, the error percentage was reduced significantly.