Assessment of inhalation technique and predictors of incorrect performance among patients of chronic obstructive pulmonary disease and asthma

Tulika Jha, Ashok Kumar Sahai, Malay Sarkar, Purshottam Kumar Kaundal, Praveen Bhardwaj, Indrajeet Sharma


Background: Poor inhalation technique is responsible for decreasing the efficacy of topical drug therapy in asthma and chronic obstructive pulmonary                 disease (COPD). Certain steps of the inhalation technique are erred most often and if ascertained, can be rectified leading to an overall improvement in the technique. The predictors for poor use can also be marked.

Methods: Inhaler technique for pressurised metered dose inhalers (pMDI), pressurised metered dose inhaler with spacer and dry powder inhaler (DPI) was assessed in one hundred and five patients who fulfilled the inclusion and exclusion criteria and were enrolled in this study. Inhaler technique was assessed using an ERAS/ISAM Task force report based scores and the lung function using pulmonary function test (PFT).The technique was re-assessed and scored after a period of three months along with the assessment of the lung function by PFT.

Results: The mean of ERS/ISAM task force report based score for evaluation of the techniques of inhalation increased from 5.79±2.58 to 8.23±2.41 (p<0.0001) after intervention. The most commonly committed error in the inhalation technique was in step number eight, ten and four by patients using pMDI, pMDI with spacer and DPI, respectively. The faulty technique being the dependent variable/outcome could be explained 16% by the type of inhaler used (r2 = 0.1607) and this is statistically significant (p<0.0001), thus the type of inhaler used was a predictor of poor use.

Conclusions: Inhaler techniques improved with systematic training and there was a trend towards improvement in lung function, hence the clinical condition.


Asthma, COPD, DPI, ERS/ISAM, pMDI+Spacer

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