Assessment of the factors affecting the failure to use inhaler devices before and after training

Background: Inhaler devices used for the treatment of chronic respiratory diseases are frequently incorrectly used by the patients. The effects of training on the correct use of these devices are unquestionable. However, despite the training provided on the correct technique of using the inhaler device, some patients still continue using the device incorrectly. The aims of the present study are to determine the rate of incorrect use of the inhaler devices, assess the parameters that affect the incorrect use, demonstrate the contribution of training, and determine the characteristics of the patients who use the devices incorrectly despite training. Methods: 342 consecutive patients were included in the study. The patients' ability to use the devices correctly was scored before and after face-to-face trainings. The parameters affecting incorrect use, the impact of training, and characteristics of the patients who continued the incorrect usage after training were evaluated. Results: The rate of correct usage was 58.9% for dry powder inhalers (DPI) and 31.1% for pressurized metered dose inhalers (pMDI) before the training. The parameters affecting correct usage were educational status, gender, living in rural areas, duration of disease, and being diagnosed and followed-up by a chest diseases specialist. The rate of correct usage increased to 92.6% for DPI and 45.2% for pMDI after the training. The factors affecting continued incorrect usage after standard training were old age and the type of the pMDI device. Conclusions: The technique for using the inhaler device should be described to the patients in a face-to-face session by the prescribing physician. Device selection should be done on a "trial" basis and it should be considered that particularly older patients and those using pMDIs continue using the devices incorrectly despite training; hence, alternative treatment options should be reviewed for these patients. (C) 2015 Elsevier Ltd. All rights reserved.