Inhalational Therapy for Airway Disease Among Adult Patients: Compliance is a Major Challenge Toward Effective Management

Abstract

Objective: To determine proportion of correct inhalation technique amongst patients with asthma and chronic obstructive pulmonary disease.

Methodology: A cross‑sectional study involving 100 known subjects of either disease condition using inhaler device for atleast one‑year reporting at chest OPD of government hospital were interviewed using pre‑tested semi‑structured interview schedule and inhalation technique determined by standard observation checklist. Each step was given a score of ‘one’ if undertaken by patient and ‘zero’ in case of non‑compliance.

Results: There were 62% male patients; 27% were illiterate; 92% were married; 32% were current smokers; average age was 50.3 (±14.5) years; 55% and 45% had asthma and COPD respectively; 60% were on MDI device and 40% were using DPI; 23% reported co‑morbid (HT/DM) condition and 27% reported occupational dust exposure while more than one‑third (36%) reported hospitalization during last one‑year due to disease condition. Inspite of clinical requirement, 45% were not taking inhaler therapy regularly and reasons elicited were lack of knowledge (32%), casual attitude (07%), financial constraints (04%) and stigma (01%). On a positive note, patients undertaking regular visit to doctors were also taking inhaler regularly (P < 0.05). However, these positive practices did not translate into satisfactory inhaler performance. Majority (93%) of patients were not taking inhaler as per standard procedure i.e., only three were found undertaking all the 13‑steps for MDI while four were following all the 8‑steps for DPI use. Mean score (steps undertaken) for MDI user was 6.71 (±3.3) with a range of 0‑13 points and 4.4 (±2.4) with a range of 0‑8 score for DPI user. On further evaluation, satisfactory performance (minimum essential steps) with regard to either inhaler device was demonstrated by 25% patients only and found to be statistically associated with those not reporting any co‑morbidity (P=0.02).

Conclusion: Proper training and compliance could improve inhalation technique.

Keywords: Asthma, behavior, chest, communication, COPD, education, smoking, training