Inhaler Technique in Asthma: How Does It Relate to Patients' Preferences and Attitudes Toward Their Inhalers?
BACKGROUND
Correct inhaler technique can increase medication efficacy, reducing both dose and side effects. Patient preference for inhaler device has not been fully explored, and we hypothesized that if patients have a preference and can choose their inhaler, they might be more likely to use it correctly. Our aim was to determine the preferences, attitudes, and perceptions of patients with asthma toward their inhalers, and to evaluate whether any of these factors were related to inhalation technique.


METHODS
Twenty-five patients with asthma (mean age 43.1 years) participated. Qualitative semi-structured interviews and quantitative patient satisfaction and preference questionnaires (PASAPQ) were used to explore patients' preferences, attitudes, and perceptions about their inhalers. Objective inhalation technique assessment was performed. Data were triangulated to identify characteristics that could indicate a relationship between inhaler technique, satisfaction, preference, and decision making.


RESULTS
Themes from qualitative interviews were as follows: asthma inhalers and expectations; inhaler preference; characteristics of an ideal inhaler; perceived effectiveness of inhalers; and inhalers and patient decision making. PASAPQ scores indicated that all patients were at least "somewhat satisfied" with their inhalers, regardless of technique. Only 12% of inhalers were used correctly, despite pilot PASAPQ data suggesting that most patients were confident with their technique. The inhaler technique was unlikely to be related to satisfaction, perception of inhaler devices, or choice in device selection. Patients with correct inhaler technique were more aware of their asthma and expressed motivation to achieve optimal asthma control.


CONCLUSIONS
The majority of the asthmatic patients did not use their inhaler(s) correctly, despite most having confidence in their technique. Patients attributed confidence in their inhaler technique to their belief that their inhaler was effective. Most patients had not been involved in decision making about which inhalation device to use. These findings highlight the lack of understanding of the important role of correct inhaler technique in asthma management.
1 Woolcock Institute of Medical Research , Glebe, Australia .|2 Faculty of Pharmacy, University of Sydney , Sydney, Australia .
Lia
L
Jahedi
1 Woolcock Institute of Medical Research , Glebe, Australia .
Sue R
SR
Downie
2 Faculty of Pharmacy, University of Sydney , Sydney, Australia .|3 The NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS) , Glebe, Australia .
Bandana
B
Saini
2 Faculty of Pharmacy, University of Sydney , Sydney, Australia .|4 Advanced Drug Delivery Group, Faculty of Pharmacy, University of Sydney , Sydney, Australia .
Hak-Kim
HK
Chan
1 Woolcock Institute of Medical Research , Glebe, Australia .|5 Sydney Medical School, University of Sydney , Sydney, Australia .|6 Sydney Local Health District , Sydney, Australia .
Sinthia
S
Bosnic-Anticevich
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D003657:Decision Making; D004867:Equipment Design; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D057240:Patient Preference; D017060:Patient Satisfaction; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D055815:Young Adult
D018927:Anti-Asthmatic Agents
asthma; inhaler technique; patient preference; perception
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