Inhaler technique among adults with uncontrolled asthma from low-income Philadelphia neighborhoods
Monday, March 5, 2018
South Hall A2 (Convention Center)
Patrick K. Gleeson, Luzmercy Perez, Russell Localio, PhD, Knashawn Morales, ScD, Xiaoyan Han, MS, Maryori Canales, BS, Nadirah Lampkin, BS, Tyra Bryant-Stephens, MD, Andrea J. Apter, MD MA MSc FAAAAI
RATIONALE: Correct inhaler technique is essential for asthma control. We evaluated metered dose (MDI) and dry powder inhaler (DPI) technique in adults with uncontrolled asthma. We hypothesized that inhaler technique is suboptimal, and wanted to determine which steps of inhaler technique are most error-prone.

METHODS: 301 adults living in low-income Philadelphia neighborhoods were recruited. All had uncontrolled asthma, defined as requiring prednisone, an ED visit, or hospitalization for asthma in the past 12 months. At enrollment, subjects’ inhaler techniques were rated by community health workers. MDI technique was rated using inhaler guidelines from the NAEPP Expert Panel Report 3, and DPI technique by published and manufacturers’ instructions. MDI technique had 7 steps; DPI technique had 6 steps; each step was rated as ‘yes’ or ‘no.’ Incorrect steps were corrected.

RESULTS: The mean age was 49±13 years. 90% were female. 50% experienced hospitalizations and 83% had ED visits for asthma in the prior year. Among 203 patients with spirometry, mean FEV1 percent predicted was 69.5%. Of the 300 evaluable subjects, 281 were rated using MDIs; 81 were rated using DPIs. Among MDI users, 93 (33%) made at least one error. Common missed steps were exhaling before actuating the inhaler (23%), actuating only once per inhalation (19%), and breath hold for 6-10 seconds (16%). Of DPI users, 18 (22%) made at least one error. Common missed steps were inhaling deeply (11%), breath hold for 6 seconds (17%), and not blowing into the Diskus (12%).

CONCLUSIONS: MDI and DPI technique is suboptimal and should be reviewed regularly.