Do Egyptian patients use their inhalers correctly? A checklist auditing for inhalation devices usage techniques

Handling of inhaler devices in actual Egyptian pulmonary clinical care practice is not well studied. This study aims at performing checklist audit regarding the Egyptian patients’ usage technique of the inhalation devices. Asthma or chronic obstructive pulmonary disease (COPD) patients using any type of inhaler devices in 9 various health services in 3 different Egyptian governorates were recruited during the period between April 2011 and June 2012. Patients were asked to demonstrate their inhaler techniques and errors were recorded against inhaler-specific checklists. Then patients were interviewed regarding their knowledge of inhalation devices. We included 533 patients (71.9% asthma and 28.1% COPD). Pressurized metered dose inhalers (MDI), Diskus, aerolizer/handihaler and turbuhaler were used by 70.5%, 10.5%, 14.1% and 4.9% of patients, respectively. More than 99% of asthma and COPD patients claimed to know how to use the inhaled devices. One error at least in all and essential inhalation steps was committed in 91.7% and 35.8% of the patients, respectively. Among essential steps, Diskus inhaler had the lowest rate of incorrect handling (7.1%) and MDI had the highest rate of incorrect handling (44.7%). MDI use was associated with a significant higher rate of incorrect technique than other devices. COPD group patients committed non-significant more errors than did the asthma group patients when using MDI or aerolizer/handihaler. Improper inhaler technique is common among our patients. Discrepancy between patients understanding and actual usage technique of different inhalation devices was noted.