Do the Patients with COPD Use Inhalator Correctly?

Monday, 30 July 2012

Yeonjung Lim, RN, BSN
Haejung Lee, PhD, RN
Sungmin Kim, BS
In-Ah Kim, BS
College of Nursing, Pusan National University, Yangsan, South Korea

Learning Objective 1: The learner will be able to identify steps which showed high rate of errors in inhalation technique among patients with chronic obstructive pulmonary disease (COPD).

Learning Objective 2: The learner will be able to recognize the necessity for implement educational program to assess and teach appropriate inhalation technique in patients with COPD.


This study was conducted to examine rates of inhaler misuse and to identify the steps which patients reported high rates of misusage in patients with chronic obstructive pulmonary disease (COPD).


About 197 patients diagnosed as COPD and had been treated with more than 1 inhalers participated in this study. To assess the misusage of inhaler, participants were asked to use inhalers just as if they would be at home. Observed inhaler techniques were recorded using checklists developed for this study. Data were collected by structured questionnaire from March to November, 2010 in 5 hospitals in Korea. To analyze the data, SPSS WIN 18.0 program using descriptive statistics was utilized.   


In this study, MDI (n=27), Diskus (n=111), Turbuhaler (n=32), and Handihaler (n=163) were used to manage the symptoms of COPD. About 37.6% (n=74) used only one kind of inhaler, 56.9% (n=112) and 5.6% (n=11) used 2 and more than 2 kinds of inhalers, respectively. Mean (SD) score of the correct use of inhaler was 86.7 (16.9) in MDI, 87.1 (12.8) in Diskus, 85.1 (10.4) in Turbuhaler, and 78.8 (17.3) out of 100 in Handihaler. The step which patients reported the highest rate of misusage was 'Before inhalation, breathe out gently away from inhaler'. For Handihaler, approximately 40% did not inhale one more time to ensure capsule was empty.


Correct inhaler technique is important for management of COPD and inappropriate inhalation technique reduces the effects of inhalation medicine. However, based on the results in this study, inhaler misusage was common in patients with COPD. Assessment and education the proper technique of inhalers could be useful to reduce inhaler mishandling and induce positive outcome for COPD management. Further research for identify the related factors of incorrect inhalation technique in patients with COPD is also warranted.