Associations between inhaler technique and asthma control among asthma patients using pressurised MDIs and DPIs

OBJECTIVES: To investigate associations between technique with pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) used as controller medication and asthma control variables measured using Asthma Control Test (ACT) scores. DESIGN: In this cross-sectional study, the inhaler technique of asthma patients using pMDIs or DPIs (Turbuhaler (R) [TH] and Accuhaler Diskus (TM) [ACC]) were assessed against published inhaler technique checklists. ACT scores (maximum 25, higher score corresponding to better asthma control) were assessed. RESULTS: Of the 130 subjects enrolled in the study (41 TH, 54 ACC and 35 pMDI), inhaler technique scores (out of nine for all devices) were low for TH (4.4 +/- 0.9) and ACC (5.4 +/- 1.0) compared with pMDI (8.1 +/- 0.9) (P < 0.001, one-way analysis of variance). Older age and use of pMDI were associated with better inhaler technique. ACT scores were low, consistent with very poorly controlled asthma (mean TH 13.1 +/- SD 3.9, mean ACC 13.3 +/- SD 3.9 and mean pMDI 12.8 +/- SD 4.2). No significant association between inhaler technique scores and ACT scores was found. More recent asthma diagnosis and a higher level of education were associated with higher ACT scores (better asthma control). CONCLUSION: Asthma control was poor in this population. Lack of a significant association between the inhaler technique score and asthma control may reflect the multiple factors contributing to poor asthma control in the Jordanian population.