Assessment Of Inhalation Techniques Among Adult Asthma Patients Using Pressurized Metered Dose Inhalers At Kenyatta National Hospital

Abstract

Background: It is projected that by the year 2025, approximately 100 million world citizens will be asthmatic. Currently, prevalence of asthma in Kenya is estimated at about 10% and it's bound to rise with increased urbanization which predisposes to allergens. Inhalation therapy is the mainstay of asthma management because it delivers drug directly to the airways with potent therapeutic effects and minimal systemic side effects. According to Global Initiative for Asthma, inhaled corticosteroids are the most effective controller medication currently available while short acting beta agonists are the mainstay for acute asthma symptoms. All asthma patients on inhaler medication should be assessed on inhalation technique at every clinic visit. Thus, the success of asthma control is highly dependent on performance of correct inhalation technique to deliver drug to target organ. Study design: Hospital based cross-sectional descriptive study. Study objectives: To assess the performance of inhalation techniques as per the United States National Heart, Lung and Blood Institute 2007 guidelines. Study population: Asthmatic patients aged 12 years and above refilling pressurized metered dose inhalers at Kenyatta National Hospital. Methodology: Systematic sampling was used to enrol a total of 100 asthmatic adult patients. Performance of inhalation technique was assessed, FEV 1 measured and a questionnaire administered. Association between patient and disease characteristics and inhalation technique were assessed using Pearson's Chi square test. . Results: The mean age of the 100 patients interviewed was 55.7 years (SD 15.8) with an age range between 29 and 90 years of which 57% were female, one-half of patients resided in rural areas. Most (62%) patients were unemployed and 41% had no formal education. In this study, 91% of patients have been trained on inhalation technique. Those who received oral instructions were 78%, while it was accompanied by demonstration in only 11%. Recent assessment of inhalation technique by a health worker was reported by 38% of the patients. None of the patients was able to perform all the steps of inhalation technique correctly. Four steps were frequently performed incorrectly namely; coordinating pressing dawn of the inhaler and breathing in slowly (62%), failure to breathe through the mouth (78%) during inhalation, continuing to breathe slowly after

actuating (60%) and failing to hold breath (58%). Correct performance of critical steps was significantly associated with good asthma control. Conclusion: None of the patients interviewed was able to perform all the steps of inhalation technique without missing atleast one step. Regular assessment of inhalation technique was significantly associated with good asthma control at Kenyatta National Hospital. Recommendation Regular assessment of inhaler technique at every clinic visit is recommended for all patients with asthma to improve asthma control at Kenyatta National Hospital.