Email updates

Keep up to date with the latest news and content from AACI and BioMed Central.

Open Access Highly Accessed Research

Improper inhaler technique is associated with poor asthma control and frequent emergency department visits

Hamdan AL-Jahdali14*, Anwar Ahmed2, Abdullah AL-Harbi1, Mohd Khan1, Salim Baharoon1, Salih Bin Salih1, Rabih Halwani3 and Saleh Al-Muhsen3

Author Affiliations

1 Department of Medicine, Pulmonary Division-ICU, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

2 Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

3 Asthma Research Chair and Prince Naif Center for Immunology Research, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia

4 King Saud University for Health Sciences, Head of Pulmonary Division, Medical Director of Sleep Disorders Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia

For all author emails, please log on.

Allergy, Asthma & Clinical Immunology 2013, 9:8  doi:10.1186/1710-1492-9-8

Published: 6 March 2013

Abstract

Background

Uncontrolled asthma remains a frequent cause of emergency department (ED) visits and hospital admissions. Improper asthma inhaler device use is most likely one of the major causes associated with uncontrolled asthma and frequent ED visits.

Objectives

To evaluate the inhaler technique among asthmatic patients seen in ED, and to investigate the characteristics of these patients and factors associated with improper use of inhaler devices and its relationship with asthma control and ED visits.

Methods

A cross-sectional study of all the patients who visited the ED with bronchial asthma attacks over a 9-month period was undertaken at two major academic hospitals in Saudi Arabia. Information was collected about demographic data and asthma management and we assessed the inhaler techniques for each patient using an inhaler technique checklist.

Results

A total of 450 asthma patients were included in the study. Of these, 176(39.1%) were males with a mean age of 42.3 ±16.7 years and the mean duration of asthma was 155.9 ± 127.1 weeks. The improper use of asthma inhaler devices was observed in 203(45%) of the patients and was associated with irregular clinic follow-ups (p = 0.0001), lack of asthma education (p = 0.0009), uncontrolled asthma ACT (score ≤ 15) (p = 0.001), three or more ED visits (p = 0.0497), and duration of asthma of less than 52 weeks (p = 0.005). Multiple logistic regression analysis revealed that a lack of education about asthma disease (OR =1.65; 95% CI: 1.07, 2.54) or a lack of regular follow-up (OR =1.73; 95% CI: 1.08, 2.76) was more likely to lead to the improper use of an asthma inhaler device.

Conclusion

Improper asthma inhaler device use is associated with poor asthma control and more frequent ED visits. We also identified many avoidable risk factors leading to the improper use of inhaler devices among asthma patients visiting the ED.

Keywords:
Asthma control; Inhaled corticosteroid; Emergency department; Inhaler devices; Asthma education