Evaluating Inhaler Use Technique among Asthma and COPD Patients at a Primary Health Care Unit: A Pilot Study in Selangor Malaysia


Zulfan Zazuli(1*), Kogilavani Ramasamy(2), I Ketut Adnyana(3)

(1) Department of Pharmacology, Clinical Pharmacy, School of Pharmacy Institut Teknologi Bandung
(2) Department of Pharmacology, Clinical Pharmacy, School of Pharmacy Institut Teknologi Bandung
(3) Department of Pharmacology, Clinical Pharmacy, School of Pharmacy Institut Teknologi Bandung
(*) Corresponding Author


Inhaler is the most preferable device to deliver medication in order to treat asthma and Chronic Obstructive Pulmonary Disease (COPD). Incorrect usage of inhaler influences the clinical effectiveness of the delivered drug. A pilot study was conducted to determine the appropriateness of inhaler handling technique among asthma and COPD patients. As many as 92 subjects whom diagnosed with asthma and COPD, aged between 18 to 64 years old were observed in this cross-sectional study. Consenting subjects on inhaler, who attended medical out patients clinic at a primary health care unit in Selangor, Malaysia were asked to demonstrate on how they use the inhaler while an inhaler administration checklist were used to assess each patients inhaler technique. Data was analysed using descriptive statistical methods. Of total 92 patients, a total of 155 devices were used. Only 4 out of 92 patients correctly handles the device (4.3%). In average, a patient made approximately >4 mistakes during pMDI inhalation and >2 mistakes during DPI inhalation. The most common mistake found among pMDI, Turbuhaler and Accuhaler users were unable to hold the breath for approximately 5 seconds in which comprise of ≥80% patients. In conclusion, majority of asthma and COPD patients use their inhaler inaccurately. Patients prescribed by inhalation medications should have routine assessment of their inhaler technique at every visit and corrected if found to be poor.


asthma; COPD; inhalation technique; compliance

Full Text:



1. Asthma GIf. Global strategy for asthma management and prevention (updated 2016). 2016.

2. GINA G. Diagnosis of Diseases of Chronic Airflow Limitation: Asthma, COPD and Asthma-COPD Overlap Syndrome (ACOS). 2015.

3. GOLD. Global Strategy for The Diagnosis, Management, And Prevention of Chronic Obstructive Pulmonary Disease (2017 Report). Global Initiative for Chronic Obstructive Lung Disease;2017.

4. Sanchis J, Gich I, Pedersen S. Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time? Chest. 2016;150(2):394-406.

5. Cochrane MG, Bala MV, Downs KE, Mauskopf J, Ben-Joseph RH. Inhaled corticosteroids for asthma therapy: patient compliance, devices, and inhalation technique. Chest. 2000;117(2):542-550.

6. Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur Respir J. 2002;19(2):246-251.

7. Baddar S, Jayakrishnan B, Al-Rawas OA. Asthma control: importance of compliance and inhaler technique assessments. J Asthma. 2014;51(4):429-434.

8. Goris S, Tasci S, Elmali F. The effects of training on inhaler technique and quality of life in patients with COPD. J Aerosol Med Pulm Drug Deliv. 2013;26(6):336-344.

9. Takemura M, Mitsui K, Itotani R, et al. Relationships between repeated instruction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2011;6:97-104.

10. Makela MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481-1490.

11. NACA. Inhaler technique for people with asthma or COPD. National Asthma Council Australia; 2016.

12. Arora P, Kumar L, Vohra V, et al. Evaluating the technique of using inhalation device in COPD and bronchial asthma patients. Respir Med. 2014;108(7):992-998.

13. Pothirat C, Chaiwong W, Phetsuk N, Pisalthanapuna S, Chetsadaphan N, Choomuang W. Evaluating inhaler use technique in COPD patients. Int J Chron Obstruct Pulmon Dis. 2015;10:1291-1298.

14. Newman SP, Weisz AW, Talaee N, Clarke SW. Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique. Thorax. 1991;46(10):712-716. 15. Yildiz F. Importance of inhaler device use status in the control of asthma in adults: the asthma inhaler treatment study. Respir Care. 2014;59(2):223-230.

DOI: https://doi.org/10.22146/jmpf.33829

Article Metrics

Abstract views : 2678 | views : 8881


  • There are currently no refbacks.

Copyright (c) 2018 JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

©Jurnal Manajemen dan Pelayanan Farmasi
Faculty of Pharmacy
Universitas Gadjah Mada
Creative Commons License
View My Stats