title: Influence of inhaler technique on asthma and COPD control: a multicenter experience.
abstract: BACKGROUND
  The successful management of asthma and chronic obstructive pulmonary disease (COPD) mostly depends on adherence to inhalation drug therapy, the usage of which is commonly associated with many difficulties in real life. Improvement of patients' adherence to inhalation technique could lead to a better outcome in the treatment of asthma and COPD.
  
  
  OBJECTIVE
  The aim of this study was to assess the utility of inhalation technique in clinical and functional control of asthma and COPD during a 3-month follow-up.
  
  
  METHODS
  A total of 312 patients with asthma or COPD who used dry powder Turbuhaler were enrolled in this observational study. During three visits (once a month), training in seven-step inhalation technique was given and it was practically demonstrated. Correctness of patients' usage of inhaler was assessed in three visits by scoring each of the seven steps during administration of inhaler dose. Assessment of disease control was done at each visit and evaluated as: fully controlled, partially controlled, or uncontrolled. Patients' subjective perception of the simplicity of inhalation technique, disease control, and quality of life were assessed by using specially designed questionnaires.
  
  
  RESULTS
  Significant improvement in inhalation technique was achieved after the third visit compared to the first one, as measured by the seven-step inhaler usage score (5.94 and 6.82, respectively;P<0.001). Improvement of disease control significantly increased from visit 1 to visit 2 (53.9% and 74.5%, respectively;P<0.001) and from visit 2 to visit 3 (74.5% and 77%, respectively;P<0.001). Patients' subjective assessment of symptoms and quality of life significantly improved from visit 1 to visit 3 (P<0.001).
  
  
  CONCLUSIONS
  Adherence to inhalation therapy is one of the key factors of successful respiratory disease treatment. Therefore, health care professionals should insist on educational programs aimed at improving patients' inhalation technique with different devices, resulting in better long-term disease control and improved quality of life.
authors: Faculty of Medicine, University of Belgrade; Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade.
authors: Aleksandra
authors: A
authors: Dudvarski Ilic
authors: Faculty of Medicine, University of Belgrade; Clinic for Pulmonology, Clinical Centre of Serbia, Belgrade.
authors: Vladimir
authors: V
authors: Zugic
authors: Faculty of Medicine, University of Novi Sad, Novi Sad; Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica.
authors: Biljana
authors: B
authors: Zvezdin
authors: Faculty of Medicine, University of Novi Sad, Novi Sad; Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica.
authors: Ivan
authors: I
authors: Kopitovic
authors: Faculty of Medicine, University of Kragujevac; Clinic for Pulmonology, Clinical Centre Kragujevac, Kragujevac.
authors: Ivan
authors: I
authors: Cekerevac
authors: Faculty of Medicine, University of Kragujevac; Clinic for Pulmonology, Clinical Centre Kragujevac, Kragujevac.
authors: Vojislav
authors: V
authors: Cupurdija
authors: Clinic for Pulmonary Diseases Knez Selo, Clinical Centre Nis, Nis.
authors: Nela
authors: N
authors: Perhoc
authors: Clinic for Pulmonary Diseases Knez Selo, Clinical Centre Nis, Nis.
authors: Vesna
authors: V
authors: Veljkovic
authors: Faculty of Stomatology, University Academy of Business Novi Sad, Novi Sad, Serbia.
authors: Aleksandra
authors: A
authors: Barac
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems / Q000295:instrumentation*; D058995:Dry Powder Inhalers; D004867:Equipment Design; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011788:Quality of Life; D055771:Serbia; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents
keywords: COPD; Turbuhaler; adherence; asthma; inhalation technique