Mohammad Mohsin Rana, Abedur Rehman, Ghazanfar Ali Sandhu, Yosouf Hassan.
Use of metered dose inhalers.
Professional Med J Jan ;12(2):145-52.

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.

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