Inhaler Technique Errors and Their Association with Disease Control in Adults with COPD and Asthma: A Cross-Sectional Study at a Tertiary Care Hospital
DOI:
https://doi.org/10.48047/appxns78Keywords:
Inhaler technique, disease control, CAT score; ACT, patient educationAbstract
Background: Correct inhaler technique is fundamental to effective drug delivery in COPD and asthma. Despite being the most commonly used treatment modality, inhaler errors are prevalent and independently associated with poor disease control, exacerbations, and hospitalisations. Device-specific characterisation of error patterns is essential for targeted patient education interventions. Methods: A cross-sectional study assessed inhaler technique using device-specific checklists in 250 adults with COPD or asthma attending a respiratory OPD at a tertiary care hospital. Disease control was assessed by CAT score (COPD) and ACT (asthma). Device types included pMDI, pMDI+spacer, DPI, and soft-mist inhaler (SMI). Multivariable regression identified predictors of poor disease control. Results: At least one critical error was made by 63.6% of patients (DPI: 71.4%; pMDI without spacer: 57.8%). Most common errors: failure to exhale fully before inhalation (52.0%), suboptimal peak inspiratory flow for DPI (38.0%), and poor pMDI-inhalation coordination (47.0%). Poor disease control was present in 52.0%; significantly associated with ≥1 critical error (61.1% vs 38.9%, p<0.001). Independent predictors: critical error (aOR 2.4), no prior inhaler counselling (aOR 2.8), age >60 years (aOR 1.7), and illiteracy (aOR 2.1). Conclusion: Critical inhaler technique errors are highly prevalent and independently predict poor disease control. Mandatory device-specific training at every clinical encounter, with in-Check DIAL assessment of peak inspiratory flow for DPI users, should be institutionalised in all respiratory outpatient clinics.
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