title: Handling of inhaler devices in actual pulmonary practice: metered-dose inhaler versus dry powder inhalers.
abstract: BACKGROUND
  Handling of inhaler devices such as pressurized metered-dose inhalers (MDIs) and dry-powder inhalers (DPIs) in actual pulmonary practice is not well studied.
  
  
  OBJECTIVE
  The aim of this study was to evaluate patients' proper handling of inhaler devices during actual pulmonary practice.
  
  
  METHODS
  Prospective observational evaluations were conducted at 3 pulmonary clinics in Jordan, from February 2006 until August 2006. MDI (without spacer), Turbuhaler, Diskus, and Aerolizer devices were studied. Incorrect handling was defined as improper technique in any of the predefined essential steps.
  
  
  RESULTS
  Patients (n = 300) were recruited and 525 inhaler-device handling technique evaluations were completed. Diskus inhaler had the lowest rate of incorrect handling (7/103, 6.8%) and MDI had the highest rate of incorrect handling (144/193, 74.6%). Turbuhaler and Aerolizer were handled incorrectly by 63/146 (43.2%) and 14/83 (16.9%) patients, respectively. DPI had a lower rate of incorrect handling, when compared with the MDI (p < 0.001). Among the DPI devices, the Diskus had the lowest rate of incorrect handling (p < 0.031).
  
  
  CONCLUSIONS
  In actual pulmonary clinical practice the majority of patients were unable to use MDI correctly, whereas correct handling of DPI devices was variable. Regular checking of inhalation technique and proper teaching by health care providers is crucial for optimum use of most inhaler devices.
authors.affiliation: Department of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan 22110. basheerk@just.edu.jo
authors.forename: Basheer Y
authors.initials: BY
authors.lastname: Khassawneh
authors.forename: Musa K
authors.initials: MK
authors.lastname: Al-Ali
authors.forename: Karem H
authors.initials: KH
authors.lastname: Alzoubi
authors.forename: Morad Z
authors.initials: MZ
authors.lastname: Batarseh
authors.forename: Saafan A
authors.initials: SA
authors.lastname: Al-Safi
authors.forename: Abdelmonem M
authors.initials: AM
authors.lastname: Sharara
authors.forename: Hatem M
authors.initials: HM
authors.lastname: Alnasr
mesh_terms: D003430:Cross-Sectional Studies; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D006801:Humans; D036501:Metered Dose Inhalers; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance; D011446:Prospective Studies