Inhaler training and asthma knowledge are associated with a higher proportion of patients with correct inhaler technique in young but not in elderly asthmatic patients

Abstract

Objective: Incorrect inhaler usage is frequent, particularly in elderly asthmatic patients. This study aimed at comparing inhaler technique errors and their determinants, as well inhaler technique self-perception versus real performance, between elderly and non-elderly asthmatics. Methods: Cross-sectional assessment of 92 elderly and 100 non-elderly asthmatics followed at specialty clinics. A standardized questionnaire was applied and inhaler technique demonstration was requested. Errors were assessed using checklists based on manufacturers’ instructions and inhaler technique was graded as correct, acceptable or incorrect. Chi-Square Test and Fischer’s Exact Test were used for comparative analysis of nominal variables. A p value equal to or less than 0.05 was considered statistically significant. Results: Inhaler technique was correct in a minority of elderly and young patients, without significant differences between study groups. Only 11.1% of the elderly who classified their inhaler as easy and 12.7% who stated their technique was correct had no errors. Previous regular inhaler training was associated with better actual performance in young but not in elderly patients. Conclusion: Our study showed that in spite of regular follow up at specialized outpatient clinics, inhaler devices are associated with a high frequency of errors in elderly and non-elderly asthmatics. In addition, most patients tend to overestimate their technique as correct. Finally, previous, frequent training was associated with a significantly higher percentage of patients showing correct or acceptable technique but only in non-elderly asthmatics, which suggests that elderly asthmatics may need specifically tailored inhaler education programs.

Keywords:

• Asthma knowledge
• determinants
• inhalers
• inhaler technique
• self-perception

Declaration of Interest & Acknowledgements

Eduardo Ferreira, Adriana Pascoal, Patrícia Silva, Olga Lourenço, Salete Valente, Mª Jesus Valente, Marli Loureiro, and Jorge M.R. Gama declare that they have no conflicts of interest in relation to this article. João A. Fonseca has received lecture fees from several pharmaceutical companies that market inhaled products. These include AstraZeneca, GlaxoSmithKline, and Novartis. He has also participated in advisory boards of Novartis. Luis Taborda-Barata has received honoraria for scientific presentations, from several pharmaceutical companies that market inhaled products. These include AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Mundipharma, Novartis, Laboratorios Vitoria. None of the authors have any shares in any pharmaceutical company.

Data availability

Data, in anonymized format may be available directly from the corresponding author.

Funding

This work was supported by FEDER funds through the POCI - COMPETE 2020 - Operational Programme Competitiveness and Internationalization in Axis I - Strengthening research, technological development and innovation (Project No. 007491) and National Funds by FCT - Foundation for Science and Technology (Project UID/Multi /00709).

Additional information

Funding

This work was supported by FEDER funds through the POCI - COMPETE 2020 - Operational Programme Competitiveness and Internationalization in Axis I – Strengthening research, technological development and innovation (Project No. 007491) and National Funds by FCT - Foundation for Science and Technology (Project UID/Multi/00709).