title: Inhaler technique maintenance: gaining an understanding from the patient's perspective.
abstract: BACKGROUND
  The aim of this study was to determine the patient-, education-, and device-related factors that predict inhaler technique maintenance.
  
  
  METHODS
  Thirty-one community pharmacists were trained to deliver inhaler technique education to people with asthma. Pharmacists evaluated (based on published checklists), and where appropriate, delivered inhaler technique education to patients (participants) in the community pharmacy at baseline (Visit 1) and 1 month later (Visit 2). Data were collected on participant demographics, asthma history, current asthma control, history of inhaler technique education, and a range of psychosocial aspects of disease management (including adherence to medication, motivation for correct technique, beliefs regarding the importance of maintaining correct technique, and necessity and concern beliefs regarding preventer therapy). Stepwise backward logistic regression was used to identify the predictors of inhaler technique maintenance at 1 month.
  
  
  RESULTS
  In total 145 and 127 participants completed Visits 1 and 2, respectively. At baseline, 17% of patients (n = 24) demonstrated correct technique (score 11/11) which increased to 100% (n = 139) after remedial education by pharmacists. At follow-up, 61% (n = 77) of patients demonstrated correct technique. The predictors of inhaler technique maintenance based on the logistic regression model (X(2) (3, N = 125) = 16.22, p = .001) were use of a dry powder inhaler over a pressurized metered-dose inhaler (OR 2.6), having better asthma control at baseline (OR 2.3), and being more motivated to practice correct inhaler technique (OR 1.2).
  
  
  CONCLUSIONS
  Contrary to what is typically recommended in previous research, correct inhaler technique maintenance may involve more than repetition of instructions. This study found that past technique education factors had no bearing on technique maintenance, whereas patient psychosocial factors (motivation) did.
authors.affiliation: Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia. ludmila.ovchinikova@sydney.edu.au
authors.forename: Ludmila
authors.initials: L
authors.lastname: Ovchinikova
authors.forename: Lorraine
authors.initials: L
authors.lastname: Smith
authors.forename: Sinthia
authors.initials: S
authors.lastname: Bosnic-Anticevich
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D032882:Comprehension; D058995:Dry Powder Inhalers / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D016017:Odds Ratio; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D010594:Pharmacies; D010595:Pharmacists; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D018927:Anti-Asthmatic Agents