Pneumology - Original Articles Open access

Evaluation of asthma control after reinforcement of proper inhaler techniques in a tertiary care center in northern India

Authors

Published
21 October 2024
Section
Pneumology - Original Articles
DOI
10.4081/monaldi.2024.3199

Abstract

Asthma is an obstructive lung disease with high prevalence. Symptom control in asthma remains poor despite significant advancements in treatment guidelines and inhalational devices. This is often attributed to inadequate patient adherence to the inhaler technique and insufficient education on its long-term use. Through this study, we aimed to assess the impact of reinforcement of proper inhaler technique on asthma symptom control and quality of life. A prospective cohort of 400 asthma patients using dry powder inhalers and metered dose inhalers was recruited in the outpatient clinic of our hospital. At the time of recruitment, the correctness of inhaler technique usage was assessed, and the pre-test Inhaler Technique Score (ITS) was recorded for each patient. Then, a ten-step inhalation technique was taught through demonstration, and the post-test ITS score was recorded again. This was done for each patient at monthly intervals for 3 months. Along with it, two tailored questionnaires, the Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire (AQLQ), were administered at each visit to assess disease control and quality of life. Significant enhancements in inhalation technique were noted from the first to the third visit using the ten-step inhalation usage scores, which improved from 6.91 to 9.87 (out of 10) (p<0.001), paralleled by ACT score increases from 17.06 to 19.37 (out of 25) (p<0.001) from visits one to two, and from 19.37 to 20.52 (out of 25) (p<0.001) from visits two to three, signifying improvement in symptom control. Quality of life similarly improved from 4.45 to 5.12 to 5.45 (out of 7) (p<0.001) across the three visits as assessed by AQLQ. In conclusion, promoting proper inhaler technique through structured education programs is crucial for optimizing long-term asthma management and enhancing patients’ quality of life.

Keywords

Ethics Approval

Ethical clearance obtained from the Institutional Ethics Committee, VMMC, and Safdarjung Hospital, New Delhi with serial no. IEC/VMMC/SJH/Thesis/06/2022/CC-240 dated 11th July 2022.

References

  1. Boulet LP, Reddel HK, Bateman E, et al. The global initiative for asthma (GINA): 25 years later. Eur Respir J 2019;54:1900598. DOI: https://doi.org/10.1183/13993003.00598-2019
  2. Virchow JC, Crompton GK, Dal Negro R, et al. Importance of inhaler devices in the management of airway disease. Resp Med 2008;102:10-9. DOI: https://doi.org/10.1016/j.rmed.2007.07.031
  3. Bousquet J, Mantzouranis E, Cruz AA, et al. Uniform definition of asthma severity, control, and exacerbations: document presented for the World Health Organization consultation on severe asthma. J Allergy Clin Immunol 2010;126:926-38. DOI: https://doi.org/10.1016/j.jaci.2010.07.019
  4. Westerik JA, Carter V, Chrystyn H, et al. Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting. J Asthma 2016;53:321-9. DOI: https://doi.org/10.3109/02770903.2015.1099160
  5. Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Resp Med 2011;105:930-8. DOI: https://doi.org/10.1016/j.rmed.2011.01.005
  6. Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD. J Gen Intern Med 2011;26:635-42. DOI: https://doi.org/10.1007/s11606-010-1624-2
  7. Van der Palen J, Klein JJ, Kerkhoff AH, et al. Evaluation of the effectiveness of four different inhalers in patients with chronic obstructive pulmonary disease. Thorax 1995;50:1183-7. DOI: https://doi.org/10.1136/thx.50.11.1183
  8. Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Resp Med 2008;102:593-604. DOI: https://doi.org/10.1016/j.rmed.2007.11.003
  9. Dekhuijzen PN, Vincken W, Virchow JC, et al. Prescription of inhalers in asthma and COPD: towards a rational, rapid and effective approach. Resp Med 2013;107:1817-21. DOI: https://doi.org/10.1016/j.rmed.2013.09.013
  10. Price D, Bosnic-Anticevich S, Briggs A, et al. Inhaler competence in asthma: common errors, barriers to use and recommended solutions. Resp Med 2013;107:37-46. DOI: https://doi.org/10.1016/j.rmed.2012.09.017
  11. Vestbo J, Hurd SS, Agustí AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Resp Crit Care Med 2013;187:347-65. DOI: https://doi.org/10.1164/rccm.201204-0596PP
  12. Singh S, Salvi S, Mangal DK, et al. Prevalence, time trends and treatment practices of asthma in India: the Global Asthma Network study. ERJ Open Res 2022;8:00528-2021. DOI: https://doi.org/10.1183/23120541.00528-2021
  13. Jahedi L, Downie SR, Saini B, et al. Inhaler technique in asthma: how does it relate to patients' preferences and attitudes toward their inhalers? J Aerosol Med Pulm Drug Deliv 2017;30:42-52. DOI: https://doi.org/10.1089/jamp.2016.1287
  14. Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Resp Crit Care Med 2007;175:661-6. DOI: https://doi.org/10.1164/rccm.200611-1717OC
  15. Scullion J. The nurse practitioners' perspective on inhaler education in asthma and chronic obstructive pulmonary disease. Can Respir J 2018;2018:2525319. DOI: https://doi.org/10.1155/2018/2525319
  16. Schatz M, Sorkness CA, Li J, et al. Asthma control test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol 2006;117:549-56. DOI: https://doi.org/10.1016/j.jaci.2006.01.011
  17. Juniper EF, Buist AS, Cox FM, et al. Validation of a standardized version of the asthma quality of life questionnaire. Chest 1999;115:1265-70. DOI: https://doi.org/10.1378/chest.115.5.1265

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2024 The Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.