USE OF METERED DOSE INHALERS

PATIENT’S FEARS AND OBJECTIONS, ERRORS IN THEIR TECHNIQUES. A REFLECTION OF POOR PATIENT EDUCATION IN ASTHMATICS

Abstract

Inhalational bronchodilators and anti-inflammatory therapy is the ideal
treatment for asthmatics. Successful management depends on active and continuous interaction between the clinician
and a well-educated patient. Detailed interview of patients were carried out to determine the patients’ fears about MDI
and the errors in technique were recorded. This would highlight the common deficiencies in the management in our
own socioeconomic setup. Materials and methods: Any patient with a diagnosis of Bronchial Asthma was assessed
for the competency of diagnosis. A specially trained nurse interviewed the eligible patients on a prescribed performa
who were using MDI to determine their fears and objections on its use. They were asked to demonstrate their technique
of MDI use and errors were noted. The physician checked all the information and confirmed that technique has been
corrected and the fears addressed. Patients below the age of 16 or over the age of 60 were excluded. Seriously sick
patients and patients of COPD were excluded. Asthmatics presently not using MDI were excluded. Study was carried
out from January to December 2003. Results: 192 patients were enrolled during one-year period, from January to
December 2003, in this study. There were 112 males and 80 females 46% of patients rejected MDI considering it as
the last resort, 54% perceived it as costly, for 58% it was a complicated way to use medicine, 54% considered it ineffective,
50% feared life long dependency, 54% disliked it as MDI would incite cough, 29% objected on the oral thrush
and 13% on dysphonia associated with them and for 21% it was socially un-acceptable to use MDI in public. When
inhalation technique for MDI was checked, all checked for empty canister by shaking. 92% could find out if the demo
canister was empty. All removed the cap properly. 92% shaked the MDI before use while 8% failed to do so. 79% used
it in proper upside-down position. Hand-Lung co-ordination was proper in only 29% of patients. 49% held their breath
for adequate time. 38% made proper slow exhalation. 38% performed actuation with open mouth and 63% with mouth
closed on MDI mouthpiece. 33% swallowed the drug after actuation, leakage from mouth was seen in 29% and leakage
of fumes from nose was seen in 54% of patients. Multiple actuations were done by 50% of patients. Discussion:
Bronchial Asthma is a common clinical disorder requiring long-term treatment. Inhalational delivery systems like MDI
are the ideal mode of therapy. Use of MDI is stigmatized, partly contributed by patients’ dissatisfaction from results due
to improper technique and partly attributed to the social inhibitions attached to its use. We defined, addressed and made effort to correct their technique. More emphasis on different aspects of patient education is the only way to
improve our standard of Asthma care.