title: Evaluation of inhaler techniques among asthma patients seen in Nigeria: an observational cross sectional study.
abstract: BACKGROUND
  An Adequate and an effective dose of inhalation drugs can be administered only if the correct inhaler-specific technique is followed by asthma patients. There is paucity of data on this subject among Nigerians and Africans.
  
  
  OBJECTIVE
  This observational study was to assess the inhaler techniques among asthma patients in Nigeria and also to identify the factors related to an inaccurate or poor inhaler use.
  
  
  METHODS
  Consenting asthma patients on inhalers, who attended medical out-patients clinic, of two university hospitals in Nigeria were asked to use their inhalers while an inhaler-administration checklist was used to assess each patients inhaler technique. Information on demographics, asthma symptoms history and history of technique education were obtained. Data was analyzed using standard statistical methods.
  
  
  RESULTS
  A total of 140 asthma patients participated out of which 75 were females. All the patients used pressurized metered dose inhalers (pMDI) type; 51 of them used dry powder inhalers (DPI) in addition. For pMDI, 22.1% (31/140) completed all required steps while 37.3% (19/51) did so for DPI (P = 0.04). Patients with higher educational qualification (P < 0.01) and those with less frequent asthma symptoms (P < 0.01) are more likely to use the pMDI inhalers more accurately while patients who have been taught previously by a Doctor were more likely to use the DPI better.
  
  
  CONCLUSIONS
  Majority of asthma patients use their inhalers inaccurately. Patient-dependent factors were identified as the cause of incorrect technique of inhaler use. Asthma patients on inhalation medications should have routine assessment of their inhaler technique at every visit and corrected if found to be poor.
authors.affiliation: Department of Medicine, Respiratory Unit, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
authors.forename: Cc
authors.initials: C
authors.lastname: Onyedum
authors.affiliation: Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.
authors.forename: Oo
authors.initials: O
authors.lastname: Desalu
authors.affiliation: Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
authors.forename: Ni
authors.initials: N
authors.lastname: Nwosu
authors.affiliation: Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
authors.forename: Cj
authors.initials: C
authors.lastname: Chukwuka
authors.affiliation: Federal Teaching Hospital, Abakiliki, Ebonyi State, Nigeria.
authors.forename: Kn
authors.initials: K
authors.lastname: Ukwaja
authors.affiliation: Department of Medicine, Medical Division, Nigerian Ports Authority, Lagos, Nigeria.
authors.forename: C
authors.initials: C
authors.lastname: Ezeudo
keywords: Asthma; Dry powder inhalers; Inhaler technique; Inhaler-administration checklist; Pressurized metered dose inhaler