Adult asthma patients' knowledge of the correct use of inhalers
A cross-sectional study
DOI:
https://doi.org/10.14528/snr.2025.59.2.3273Keywords:
asthma, nurses, health education, nebulisers, powder inhalersAbstract
Introduction: Asthma is one of the most common chronic diseases in the world. Modern asthma treatments rely on administering medication directly into the patient's irways. It is therefore important for patients to be familiar with the correct handling and use of inhalers, as this enables them to control their disease and take appropriate action in the event of an exacerbation of the condition. The aim of this study is to assess asthma patients' knowledge of inhaler handling.
Methods: We adopted a quantitative, non-experimental research method with a questionnaire and an observation checklist based on a total of 105 patients attending a regular asthma check-up at the pulmonology outpatient clinic of the selected health centre from 5 September to 5 December 2022.
Results: The results indicate that at least one step in the process of administering inhaler medication was performed incorrectly by the majority (n = 71) of patients. Participants' knowledge varied depending on the type of inhaler used, with more errors observed when using dry powder inhalers. Irregularities occurred mainly during the initial deep exhalation and the breath-hold following inhalation.
Discussion and conclusion: Our findings emphasise the importance of regular monitoring and repeated instruction in inhaler technique, even in long-term asthma patients. This monitoring is particularly important for asthma patients using dry powder inhalers.
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Antoljak, N. (2021). Epidemiology of asthma and chronic obstructive pulmonary disease. Medicus, 30(2), 139–144. https://hrcak.srce.hr/264139
Basheti, I. A., Obeidat, N. M., & Reddel, H. K. (2017). Effect of novel inhaler technique reminder labels on the retention of inhaler technique skills in asthma: A single-blind randomized controlled trial. NPJ Primary Care Respiratory Medicine, 27(1), Article 9. https://doi.org/10.1038/s41533-017-0011-4 PMid:28184045; PMCid:PMC5434787
Chogtu, B., Holla, S., Magazine, R., & Kamath, A. (2017). Evaluation of relationship of inhaler technique with asthma control and quality of life. Indian Journal of Pharmacology, 49(1), 110–115. https://doi.org/10.4103/0253-7613.201012 PMid:28458433; PMCid:PMC5351222
Field, A. (2009). Discovering statistics using SPSS (3rd ed.). SAGE Publications.
Kocks, J. W. H., Chrystyn, H., van der Palen, J., Thomas, M., Yates, L., Landis, S. H., Driessen, M. T., Gokhale, M., Sharma, R., & Molimard, M. (2018). Systematic review of association between critical errors in inhalation and health outcomes in asthma and COPD. NPJ Primary Care Respiratory Medicine, 28, Article 43. https://doi.org/10.1038/s41533-018-0110-x PMid:30446655; PMCid:PMC6240098
Kodeks etike v zdravstveni negi in oskrbi Slovenije in Kodeks etike za babice Slovenije. (2014). Ljubljana: Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije.
Košnik, M., Triller, N., & Šelb, J. (2017). Mnenje pulmologov o pomenu vdihovalnikov pri bolnikih z astmo ali KOPB. Zdravniški vestnik, 86, 105–114. https://doi.org/10.6016/ZdravVestn.2472
Kragelj, D. (2017). Vloga diplomirane medicinske sestre pri edukaciji pacienta z astmo [diplomska naloga, Fakulteta za zdravstvo Angele Boškin]. http://datoteke.fzab.si/diplomskadela/2017/Kragelj_Dolores.pdf
Maepa, H. M., Wong, M. L. & Menezes, C. N. (2019). Evaluation of the knowledge and correct use of metered-dose inhalers by healthcare professionals and medical students in Gauteng Province. African Journal of Thoracic And Critical Care Medicine, 25(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278855/ PMCid:PMC8278855
Mohd, A. N. B., Lee, P. Y., Cheong, A. T., & Anand, A. R. N. (2021). Factors associated with improper metered-dose inhaler technique among adults with asthma in a primary care clinic in Malaysia. Malaysian Family Physician, 16(2), 58–66. https://doi.org/10.51866/oa1231 PMid:34386165; PMCid:PMC8346752
Price, D. B., Román-Rodríguez, M., McQueen, R. B., Bosnic- Anticevich, S., Carter, V., Gruffydd-Jones, K., Haughney, J., Henrichsen, S., Hutton, C., Infantino A., Lavorini, F., Law L. M., Lisspers, K., Papi, A., Ryan, D., Ställberg, B., Van der Molen, T., & Chrystyn, H. (2017). Inhaler errors in the CRITIKAL study: Type, frequency, and association with asthma outcomes. The Journal of Allergy And Clinical Immunology in Practice, 5(4), 1071–1081. https://doi.org/10.1016/j.jaip.2017.01.004 PMid:28286157
Price, D. B., Thomas, V., Dekhuijzen, R. P. N., Bosnic-Anticevich, S., Roche, N., Lavorini, F., Raju P., Freeman D., Nicholls, C., Small IR., Sims, E., Safioti G., Canvin J., & Chrystyn, H. (2018). Evaluation of inhaler technique and achievement and maintenance of mastery of budesonide/formoterol Spiromax® compared with budesonide/formoterol Turbuhaler® in adult patients with asthma: The easy low instruction over time (ELIOT) study. BMC Pulmonary Medicine, 18(1), Article 107. https://doi.org/10.1186/s12890-018-0665-x PMid:29954359; PMCid:PMC6022306
Rehman, A., Amin, F., & Sadeeqa, S. (2018). Prevalence of asthma and its management: A review. Journal of the Pakistan Medical Association, 68(12), 1823–1827. https://jpma.org.pk/article-details/8974?article_id=8974
Sanchis, J., Gich, I., & Pedersen, S. (2016). Systematic review of errors in inhaler use: Has patient technique improved over time? Chest Journal, 150(2), 394–406. https://doi.org/10.1016/j.chest.2016.03.041 PMid:27060726
Scullion, J. (2018). The nurse practitioners´ perspective in inhaler education in asthma and chronic obstructive pulmonary disease. Canadian Respiratory Journal, 2018, Article 2525319. https://doi.org/10.1155/2018/2525319 PMid:30154941; PMCid:PMC6098863
Škrgat, S. (2016). Klinična slika, diagnoza ter zdravljenje in samozdravljenje astme. In L. Prestor (ed.), Astma in kronična obstruktivna bolezen: zbornik predavanj/Sekcija medicinskih sester in zdravstvenih tehnikov v pulmologiji, Zreče, 8.-9. april 2016 (pp. 17–20). https://www.zbornica-zveza.si/wpcontent/uploads/2019/12/Astma-in-kronicna-obstruktivnabolezen-2016.pdf
Škrgat, S., Petek, D., Košnik, M., Hudoklin, I., Zidarn, M., Triller, N., Kopač, P., Poplas Susič, T., Letonja, S., Kajba, S., Ogrič Lapajne, A., Koren, I., Novakovič, J., Rozman, I., Šorli, J., Gabrijelčič, J., Edelbaher, N., Šubic, T., Šegota, N., … Fležar, M. (2022). Predlog za obravnavo bolnika z astmo na primarni in pulmološki specialistični ravni v Sloveniji. Zdravniški vestnik, 91(9–10), D47–D66. https://doi.org/10.6016/ZdravVestn.3325
Takaku, Y., Kurashima, K., Ohta, C., Ishiguro, T., Kagiyama, N., Yanagisawa, T., & Takanayagi, N. (2017). How many instructions are required to correct inhalation errors in patients with asthma and chronic obstructive pulmonary disease? Respiratory Medicine, 123, 110–115. https://doi.org/10.1016/j.rmed.2016.12.012 PMid:28137486
Usmani, O. S. (2019). Choosing the right inhaler for your asthma or COPD patient. Therapeutics and Clinical Risk Management, 15, 461–472. https://doi.org/10.2147/TCRM.S160365 PMid:30936708; PMCid:PMC6422419
Usmani, O. S., Lavorini, F., Marshall, J., Dunlop, W. C. N., Heron, L., Farrington, E., & Dekhuijzen, R. (2018). Critical inhaler errors in asthma and COPD: A systematic review of impact on health outcomes. Respiratory research 19, Article 10. https://doi.org/10.1186/s12931-017-0710-y
Von Schantz, S., Katajavuori, N. & Juppo, A. M. (2018). The use of video instructions in patient education promoting correct technique for dry powder inhalers: An investigation on inhalernaïve individuals. Pharmacy, 6(4), Article 106. https://doi.org/10.3390/pharmacy6040106 PMid:30274303; PMCid:PMC6306773
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. Journal of the American Medical Association, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 PMid:24141714
Zakovšek, A. (2018). Vpliv načrtovane zdravstvene vzgoje na pacientovo obvladovanje astme [diplomska naloga, Univerza v Ljubljani].
Zarmouh, A. (2019). Does clinic-based education have a sustainable impact on asthma patient awareness? Libyan Journal of Medicine, 14(1), Article 1635843. https://doi.org/10.1080/19932820.2019.1635843 PMid:31238815; PMCid:PMC6598476
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