Article:

The Ineffective Use of Inhalers in Chronic Obstructive Pulmonary Disease

Abstract Chronic Obstructive Pulmonary Disease (COPD) is the most common adult respiratory disease in Nepal. It is disabling condition and requires the use of inhaled and/or oral medications for stabilisation. Inhaled medications are preferable to oral medications because of their superior effect and lack of side effects. Spacer device are also available; these reduce the need for inhaler co-ordination. The aims of this study were to determine a) the percentage of patients with COPD attending the medical clinic who use inhaled medication. b) the skill level of patients regarding inha ler technique. c) the benefit of inhaler technique counselling for improving patient skill level. In this prospective randomised study we interviewed 95 patients with COPD over a 4-month period. Thirty-three patients were regularly using inhalers, but 100% had an unsatisfactory inhaler technique. Only one patient used a spacer device. Thirty percent of patients claimed that they had never been shown how to use the inhaler. Subsequent demonstration of inhaler technique by a doctor improved skill level in 85% of patients but resulted in a satisfactory inhaler technique score for only one patient. Although this is a small study, it is probably representative of the patient population with COPD who attend our clinics. Patients, especially the elderly, have considerable difficulty activating and using MDI – despite demonstration. Doctors infrequently prescribe spacers and the cost of these excludes many patients from using them. Keywords: chronic obstructive pulmonary disease, metered dose inhalers, inhaler technique, spacers