EVALUATION OF CONVENTIONAL PRESS-AND-BREATHE METERED-DOSE INHALER TECHNIQUE IN 501 PATIENTS

Conventional press-and-breathe metered dose inhalers (MDIs) are widely prescribed but are often difficult for many patients to properly use. A total of 501 patients from different medical specialties were enrol led in this study, which evaluated how the patients used their MDIs. U sing a conservative method (minimum number of errors) of determining e rrors, we found that 388 (77.5%) of the patients made at least one err or when demonstrating how they use their MDI for two observers. Using a liberal (maximum number of errors) method of analysis, we found that 447 (89.2%) of the patients made at least one error. There was no dif ference in errors made stratified by patient gender, patient age, or t he medical specialty that treated the patient's pulmonary disease. The two most common errors made the patients were failure to breathe out to functional residual capacity before actuation (225 by minimum metho d, 280 by maximum method) and not actuating the canister at the start of inhalation (207 by minimum method, 323 by maximum method). Of the p atients with improper timing of actuation, the majority (121 patients by minimum method and 187 patients by maximum method) actuated the can ister early. In this large patient sample, regardless of which medical specialty provided the treatment, the majority of the patients evalua ted had less than optimal MDI technique. Routine assessment of MDI tec hnique should be instituted as standard practice care.