Pitfalls of inhalation technique in chronic asthmatics. Effect of education program and correlation with peak expiratory flow

OBJECTIVE: To determine the pattern of pitfalls of inhalation technique in chronic asthmatics; to assess whether an educational program can reduce the pitfalls of inhalation technique; and to evaluate whether reduction of the pitfalls could have a positive correlation with peak expiratory flow (PEF) measurements.

METHODS: The pitfalls of inhalation technique in 106 chronic asthmatics using either metered dose inhaler (MDI) (65%) or turbuhaler (35%) were studied prospectively. The pitfalls of inhalation technique and PEF measurement were recorded before and after an educational program at first and second visit. It was performed in the outpatients asthma clinic of the King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from October 2001 until March 2002.

RESULTS: Among the MDI group; failure to breath hold for 5-10 seconds (52.2%) and failure to breath in slowly and deeply after inhaler activation (46.4%) were the most common pitfalls that have been reduced after education (20.3%, 21.7%). While in the turbuhaler group; failure to breath hold for 5-10 seconds (23.1%) and failure to twist the grip forward and backward before use (21.1%) were the most common pitfalls that have been reduced after education (0%, 0%). In both groups, the education program has been significantly contributed in reducing the mean number of pitfalls among MDI and turbuhaler users with p<0.001 and p=0.002. Moreover, the mean PEF has been improved significantly from 312.4 +/- 109.9 l/minute to 331+/- 105.8 l/minute (p=0.003).

CONCLUSION: An educational program used in the outpatients asthma clinic has been significantly reduced the pitfalls of inhalation technique. The reduction of the pitfalls correlated positively with an increase in the PEF measurement. Therefore, we recommend such an education to be used in patients using such inhalers.