title: Assessment of inhaler techniques employed by patients with respiratory diseases in southern Brazil: a population-based study.
abstract: OBJECTIVE
  To identify incorrect inhaler techniques employed by patients with respiratory diseases in southern Brazil and to profile the individuals who make such errors.
  
  
  METHODS
  This was a population-based, cross-sectional study involving subjects ≥ 10 years of age using metered dose inhalers (MDIs) or dry powder inhalers (DPIs) in 1,722 households in the city of Pelotas, Brazil.
  
  
  RESULTS
  We included 110 subjects, who collectively used 94 MDIs and 49 DPIs. The most common errors in the use of MDIs and DPIs were not exhaling prior to inhalation (66% and 47%, respectively), not performing a breath-hold after inhalation (29% and 25%), and not shaking the MDI prior to use (21%). Individuals ≥ 60 years of age more often made such errors. Among the demonstrations of the use of MDIs and DPIs, at least one error was made in 72% and 51%, respectively. Overall, there were errors made in all steps in 11% of the demonstrations, whereas there were no errors made in 13%.Among the individuals who made at least one error, the proportion of those with a low level of education was significantly greater than was that of those with a higher level of education, for MDIs (85% vs. 60%; p = 0.018) and for DPIs (81% vs. 35%; p = 0.010).
  
  
  CONCLUSIONS
  In this sample, the most common errors in the use of inhalers were not exhaling prior to inhalation, not performing a breath-hold after inhalation, and not shaking the MDI prior to use. Special attention should be given to education regarding inhaler techniques for patients of lower socioeconomic status and with less formal education, as well as for those of advanced age, because those populations are at a greater risk of committing errors in their use of inhalers.
authors.affiliation: Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Paula Duarte de
authors.initials: PD
authors.lastname: Oliveira
authors.affiliation: Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Ana Maria Baptista
authors.initials: AM
authors.lastname: Menezes
authors.affiliation: Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Andréa Dâmaso
authors.initials: AD
authors.lastname: Bertoldi
authors.affiliation: Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Fernando César
authors.initials: FC
authors.lastname: Wehrmeister
authors.affiliation: Federal University of Pelotas, Pelotas, Brazil.
authors.forename: Silvia Elaine Cardozo
authors.initials: SE
authors.lastname: Macedo
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001938:Brazil; D002648:Child; D003430:Cross-Sectional Studies; D058995:Dry Powder Inhalers / Q000009:adverse effects / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers / Q000009:adverse effects; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012959:Socioeconomic Factors; D055815:Young Adult