Evaluation of inhalation technique in patients using Dry Powder Inhaler (DPI), and the effect of patient education on their techniques- an experience from Nepal

Background: Inhalation therapy is the mainstay of treatment of many respiratory diseases. Failing to perform one or more steps of inhalation correctly can substantially reduce the effectiveness of medications. Objective: Analyze prevalence of patients using inhalation devices via incorrect technique and assess the adherence of the patients to correct technique when taught. Method: One group pretest-posttest design conducted in all patients presenting at Chest clinic of Dhulikhel Hospital, Nepal during March 2017-May 2017. Patients diagnosed of having COPD, Asthma or ACOS, and under inhalation bronchodilators in the form of DPI via Rotahaler were included. Enrolled patients were assessed for inhalation technique compliance by asking them to demonstrate their inhalation technique. After assessment, training was given until they could use the device correctly. One month later, they were re-evaluated for their technique. Results: Out of 307, 88.6% participants performed one or more of the steps incorrectly. This figure fell to 67.4% a month after the training session among the 254 patients who performed incorrectly in the initial visit. Formal training resulted in a statistically significant increase in inhalation scores before and after training (4.24±1.28 in pre-training and 6.07±0.81 post-training, p 60yrs), and (FEV1 Conclusion: Inhalation technique is mostly unsatisfactory, especially in elderly patients and those with low education level and severe obstruction. Reinforcement of correct inhalation technique is essential.