title: Improper inhaler technique is associated with poor asthma control and frequent emergency department visits.
abstract: BACKGROUND
  Uncontrolled asthma remains a frequent cause of emergency department (ED) visits and hospital admissions. Improper asthma inhaler device use is most likely one of the major causes associated with uncontrolled asthma and frequent ED visits.
  
  
  OBJECTIVE
  To evaluate the inhaler technique among asthmatic patients seen in ED, and to investigate the characteristics of these patients and factors associated with improper use of inhaler devices and its relationship with asthma control and ED visits.
  
  
  METHODS
  A cross-sectional study of all the patients who visited the ED with bronchial asthma attacks over a 9-month period was undertaken at two major academic hospitals in Saudi Arabia. Information was collected about demographic data and asthma management and we assessed the inhaler techniques for each patient using an inhaler technique checklist.
  
  
  RESULTS
  A total of 450 asthma patients were included in the study. Of these, 176(39.1%) were males with a mean age of 42.3 ±16.7 years and the mean duration of asthma was 155.9 ± 127.1 weeks. The improper use of asthma inhaler devices was observed in 203(45%) of the patients and was associated with irregular clinic follow-ups (p = 0.0001), lack of asthma education (p = 0.0009), uncontrolled asthma ACT (score ≤ 15) (p = 0.001), three or more ED visits (p = 0.0497), and duration of asthma of less than 52 weeks (p = 0.005). Multiple logistic regression analysis revealed that a lack of education about asthma disease (OR =1.65; 95% CI: 1.07, 2.54) or a lack of regular follow-up (OR =1.73; 95% CI: 1.08, 2.76) was more likely to lead to the improper use of an asthma inhaler device.
  
  
  CONCLUSIONS
  Improper asthma inhaler device use is associated with poor asthma control and more frequent ED visits. We also identified many avoidable risk factors leading to the improper use of inhaler devices among asthma patients visiting the ED.
authors.affiliation: Department of Medicine, Pulmonary Division-ICU, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Jahdalih@gmail.com.
authors.forename: Hamdan
authors.initials: H
authors.lastname: Al-Jahdali
authors.forename: Anwar
authors.initials: A
authors.lastname: Ahmed
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Harbi
authors.forename: Mohd
authors.initials: M
authors.lastname: Khan
authors.forename: Salim
authors.initials: S
authors.lastname: Baharoon
authors.forename: Salih
authors.initials: S
authors.lastname: Bin Salih
authors.forename: Rabih
authors.initials: R
authors.lastname: Halwani
authors.forename: Saleh
authors.initials: S
authors.lastname: Al-Muhsen