Magnitude and associated factors of appropriate inhaler use among patients with Chronic Obstructive Pulmonary Disease at chest clinic in St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: Institutional-based cross-sectional study

Abstract

ABSTRACT Introduction: Inhalation therapy is the backbone of Chronic Obstructive Pulmonary Disease control. Appropriate inhaler technique is crucial for the effective management of Chronic Obstructive Pulmonary Disease. Device mishandling is a big problem in clinical practice bringing a significant challenge to the optimal disease management of patients with Chronic Obstructive Pulmonary Disease. Objectives: This study aims to assess the magnitude of appropriate inhaler utilization and to identify factors influencing patient adherence to inhalers and relationships between specific inhaler errors. Methods: An institutional-based cross-sectional, using a semi-structured questionnaire and a validated tool, Test of the Adherence to Inhalers(TAI), was conducted on a sample of 257 COPD patients, who fulfilled the inclusion criteria at St. Paul’s Hospital, Millennium Medical College. Data entry was done using EPI data and analyzed using SPSS software version 26. A multivariate logistic regression analysis was used to determine variables that will be independently associated with poor inhaler technique at a p-value ≤0.05. Results: About 253 participants were included. About 61% of the participants demonstrated inappropriate inhaler use. The most commonly mis-performed critical error was failure to breathe out gently (as far as is comfortable) and failure to hold breath for 5 to 10 seconds. Being male was associated with 2.1 folds increment of appropriate inhaler use compared to female (AOR=21, 95%CI=1.16, 3.69) and study participant whose education level of collage and above had 2.9 folds increment of appropriate inhaler use compared to those of haven’t formal education (AOR=2.9, 95%CI=1.23, 6.83). Study participant who was not taking training were 60% less likely to have appropriate inhaler use compared to trained ones (AOR=0.4, 0.17, 0.90) and study participant whose duration of inhaler 10-15 years had 5.1 folds increment of appropriate inhaler use compared to whose duration of inhaler use was <1 years (AOR=5.1, 95%CI=1.32, 79.64). Conclusion: COPD patients with no training about the correct use of inhaler were 60% less likely to use the inhaler correctly compared with those patients who had the training. It is recommended that care providers could direct their focus of demonstration towards common errors, including failure to breathe out gently and to hold breathe for 5 to 10 sec. in order to increase correct inhaler use. Key words: inhaler, chronic obstructive pulmonary disease, appropriate inhaler use