title: Factors related to the incorrect use of inhalers by asthma patients.
abstract: OBJECTIVE
  To evaluate inhaler technique in outpatients with asthma and to determine associations between the correctness of that technique and the level of asthma control.
  
  
  METHODS
  This was a cross-sectional study involving patients > 14 years of age with physician-diagnosed asthma. The patients were recruited from the Asthma Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, in the city of Porto Alegre, Brazil. The patients completed two questionnaires (a general questionnaire and an asthma control questionnaire based on the 2011 Global Initiative for Asthma guidelines), demonstrated their inhaler technique, and performed pulmonary function tests. Incorrect inhaler technique was defined as the incorrect execution of at least two of the predefined steps.
  
  
  RESULTS
  We included 268 patients. Of those, 81 (30.2%) showed incorrect inhaler technique, which was associated with poor asthma control (p = 0.002). Logistic regression analysis identified the following factors associated with incorrect inhaler technique: being widowed (OR = 5.01; 95% CI, 1.74-14.41; p = 0.003); using metered dose inhalers (OR = 1.58; 95% CI, 1.35-1.85; p < 0.001); having a monthly family income < 3 times the minimum wage (OR = 2.67; 95% CI, 1.35-1.85; p = 0.008), and having > 2 comorbidities (OR = 3.80; 95% CI, 1.03-14.02; p = 0.045).
  
  
  CONCLUSIONS
  In the sample studied, incorrect inhaler technique was associated with poor asthma control. Widowhood, use of metered dose inhalers, low socioeconomic level, and the presence of > 2 comorbidities were associated with incorrect inhaler technique.
authors.affiliation: Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Associate Professor. Graduate Program in Pulmonology. Federal University of Rio Grande do Sul School of Medicine; and Pulmonologist. Porto Alegre Hospital de Clínicas, Porto Alegre, Brazil.
authors.forename: Paulo de Tarso Roth
authors.initials: Pde T
authors.lastname: Dalcin
authors.affiliation: Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Medical Student. Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil.
authors.forename: Denis Maltz
authors.initials: DM
authors.lastname: Grutcki
authors.affiliation: Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Medical Student. Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil.
authors.forename: Paola Paganella
authors.initials: PP
authors.lastname: Laporte
authors.affiliation: Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Medical Student. Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil.
authors.forename: Paula Borges de
authors.initials: PB
authors.lastname: Lima
authors.affiliation: Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Medical Student. Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil.
authors.forename: Samuel Millán
authors.initials: SM
authors.lastname: Menegotto
authors.affiliation: Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil, Adjunct Professor. Federal University of Rio Grande do Sul School of Medicine, Porto Alegre, Brazil.
authors.forename: Rosemary Petrik
authors.initials: RP
authors.lastname: Pereira
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000503:physiopathology* / Q000628:therapy*; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000295:instrumentation / Q000379:methods*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires