A novel approach of using educational pharmaceutical pictogram for improving inhaler techniques in patients with asthma

Background: Proper inhaler technique is essential to maximize the benefit of medications and improve asthma outcomes. Objective: To evaluate newly developed pictogram-incorporated medals and their utility on improving the inhaler techniques in asthmatic patients. Methods: A prospective, an open label, randomized controlled clinical study was conducted in Jordan from November 2016 to November 2017. The recruited patients were randomly allocated into two groups; control and intervention. Both groups were verbally counselled about proper use of their inhaler devices, however, pictogram medals were attached to the inhalers of patients in the intervention group only. Both groups were ma at baseline and followed-up after 3 months to evaluate their inhaler techniques using standard checklists. Results: Of the 219 patients that were recruited and randomized in our study, 49.8% (n = 109) were allocated in the intervention group and 50.2% (n = 110) were in the control group. Both groups had comparable baseline demographics and clinical data (P > 0.05). Significant differences in the improvement of metered dose inhaler (MDI; p < 0.001) and Turbohaler (p = 0.005) techniques were observed between the two groups at the end of study. Patients who used MDI (OR = 7.06, 95% CI = 3.21-15.56, p < 0.001) and Turbohaler (OR = 5.08, 95% CI = 1.57-16.43, p = 0.007) in the intervention group were 7 and 5 times more likely to have improved inhaler techniques as compared to those in the control group respectively. Conclusions: Educational pharmaceutical pictograms represent an inexpensive and feasible intervention that can positively affect the proper use of inhalers in asthmatic patients.