title: Incorrect use of metered-dose inhalers in adult patients at a hospital in Callao, Peru, 2014: cross-sectional study.
abstract: BACKGROUND
  Inhalation therapy has proven to be the best way to control the asthma and chronic obstructive pulmonary disease symptoms. The most commonly used delivery system to control these symptoms is the metered-dose inhaler. The primary goal of this study is to demonstrate an association between incorrect inhaler use and patient age.
  
  
  METHODS
  This is a cross-sectional study, performed at Centro Médico Naval Cirujano Mayor Santiago Távara, in Callao, Peru, in 2014. Patients older than 18 years that used metered-dose inhalers were included. We used film recordings of patients using a metered-dose inhaler and compared their technique with the recommendations on the guidelines on the correct use of inhalers of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). The main variables measured were age and incorrect inhaler use. The results were analyzed with the Chi squared test for bivariate analysis, and for multivariate analysis we used the Poisson regression model with robust variance.
  
  
  RESULTS
  We included 378 patients in the analysis; 167 were older than 60 years. An association was found between incorrect inhalator technique and age (p=0.014) (PR 1.19 95% CI 1.03 to 1.37). The highest prevalence of incorrect technique was found in the young adult population (88%). There was no association between the incorrect technique and the person who taught it (p=0.114). Finally, this study showed that 81.2% of the study population presented an incorrect inhalation technique.
  
  
  CONCLUSIONS
  The percentage of incorrect inhaler use, in the general population is high. Even if we found no association between an incorrect technique and the person who taught it; still, there is a high percentage of errors and it was even demonstrated that being instructed by a pulmonologist does not guarantee a correct performance of metered-dose inhaler inhalations.
authors.affiliation: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú. Address: Prolongación Primavera 2390, Lima 15023, Perú. Email: alexandra.cayo@gmail.com.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cayo-Quiñe
authors.affiliation: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú
authors.forename: Valeria
authors.initials: V
authors.lastname: Martínez-Vargas
authors.affiliation: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú
authors.forename: Rossi
authors.initials: R
authors.lastname: Bustamante-Voysest
authors.affiliation: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú
authors.forename: Alejandro
authors.initials: A
authors.lastname: Piscoya
authors.affiliation: Centro Médico Naval Cirujano Mayor Santiago Távara, Callao, Perú
authors.forename: Yeny
authors.initials: Y
authors.lastname: Alberca
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000367:Age Factors; D001249:Asthma / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D015999:Multivariate Analysis; D010568:Peru; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012646:Self Administration / Q000592:standards*
keywords: age factors; asthma; chronic obstructive pulmonary disease; metered dose inhaler