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Inhaler technique errors in Romanian patients with asthma – a multicenter study

Authors Munteanu LA, Fildan AP, Tudorache E, Fira-Mladinescu O, Frandes M, Timar B, Oancea C, Tofolean DE

Received 22 March 2019

Accepted for publication 7 July 2019

Published 19 August 2019 Volume 2019:13 Pages 1401—1414


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Laura Adela Munteanu,1 Ariadna Petronela Fildan,2 Emanuela Tudorache,1 Ovidiu Fira-Mladinescu,1 Mirela Frandes,3 Bogdan Timar,3 Cristian Oancea,1 Doina Ecaterina Tofolean2

1Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2Faculty of Medicine, Internal Medicine Discipline, Medical Clinical Disciplines I, “Ovidius” University of Constanta, Constanta, Romania; 3Department of Biostatistics and Medical Informatics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania

Correspondence: Ariadna Petronela Fildan
Faculty of Medicine, Internal Medicine Discipline, Medical Clinical Disciplines I, “Ovidius” University of Constanta. Aleea Universitatii nr.1, Constanta 900470, Romania
Tel +40 74 115 7526

Background: Non-adherence to treatment is associated with poor asthma control, increased exacerbations, decline in lung function, and decreased quality of life. M-health applications have become increasingly in the last years, but little research regarding the efficiency of the instructional videos for correct inhaler use exist. The aim of this study is to assess and improve the inhalator technique and to establish which types of errors were made more often with the help of a mobile health application.
Materials and methods: Seventy-five patients with partially controlled or uncontrolled asthma, using any of turbuhaler, diskus, pressurized metered dose inhaler (pMDI) or soft mist inhaler (SMI), were included in the study. When they first entered the study, the patient’s inhaler technique was assessed by a trained medical professional and the technique errors were categorized in handling, respectively inhalation errors. After the first evaluation, the patients downloaded an application on their Smartphone and were encouraged to use the application as much as needed to remind them the correct inhalation technique. The patients were re-called every three months for evaluation, treatment, and assessment of inhalation technique.
Results: We analyzed both handling and inhalation errors for each of the four considered inhalers. We observed a significantly reduced number of inhalation technique errors after using the mobile phone application. Turbuhaler median errors were 6.00, and after six months we did not observe errors. Diskus median error was 6.00, and after six months we observed a maximum of one error. pMDI median errors were 7.00, and after six months we observed just one error. Similarly, SMI median error was 7.00, and after six months we observed just one error.
Conclusion: Although technique inhalation errors are very common among asthma patients, video instructions provided through specific mobile phone applications could improve the inhaler technique in order to achieve a better control of the disease.

Keywords: inhaler device, mobile phone application, adherence

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