Evaluation of the Association between Inhaler technique and adherence in Asthma Control: Cross-Sectional Comparative Analysis Study between Amman and Baghdad

Main Article Content

Zainab M. Al-kilkawi
Iman A. Basheti
Nathir M. Obeidat
Muhannad RM Saleh
Salim Hamadi
Reem Abutayeh
Razan Nassar
Ahmad R. Alsayed

Keywords

asthma, inhaler technique, adherence, control, Middle East

Abstract

Purpose: Asthma is a chronic condition affecting millions of people all around the world. Asthma has no cure, but disease control is essential and highly recommended. However, the available tools for asthma control assessment don’t include factors such as inhaler technique and adherence. This study aimed to assess the correlation between inhaler techniques, adherence, and level of asthma control in two different healthcare settings; Jordan and Iraq. Patients and methods: A cross-sectional observational study was con-ducted over six months, from January to August 2018, in two public hospitals in Amman (Jordan) and Baghdad (Iraq). Asthmatic patients were interviewed to assess their inhaler technique, adherence, and asthma control. The researcher personally visited both public hospitals, conducting face-to-face interviews with patients at the hospital outpatient clinics. Validated questionnaires were used for patient assessment, including demographics, asthma history and medication use, the patient’s inhaler technique, adherence, and asthma control. Results: A total of 300 patients entered the study, with a mean age of 45.54 ± 13.71. The asthma control test showed very poor asthma control for patients living in both countries (Amman n=78 (52.0%) vs. Baghdad n=106 (70.0%)). An asthma knowledge assessment showed that most asthmatic patients in both countries didn’t follow their asthma medication plan (Amman n=78 (52.0%) vs. Baghdad n=93 (62.0%). Conclusion: In both Jordan and Iraq, asthma patients were found to be poorly controlled. Knowledge of patients was inadequate, probably leading to the poorly managed chronic disease. The results of this study highlight the significance of the pharmacist’s role in recognizing asthmatic patients requiring assistance. Furthermore, they underscore the pharmacist’s pivotal contribution to delivering patient education and counseling, ultimately resulting in enhanced asthma control.

Abstract 347 | PDF Downloads 361

References

1. Papi, A, Brightling, C, Pedersen, et al. Asthma. Lancet Publishing Group: 2018;391:783-800.
2. Stern, J, Pier, J Litonjua, et al. Asthma epidemiology and risk factors. Springer.2020;42:5-15. https://doi.org/10.1007/s00281- 020-00785-1
3. GINA Global initiative for asthma (GINA):strategy for asthma management and prevention. (1 october).
4. Tarasidis, G. S, Wilson, K. F, et al. Diagnosis of asthma: clinical assessment. Int Forum Allergy Rhinol. 2015;5(1):S23-6. https:// doi.org/10.1002/alr.21518
5. Al-Dulaimi, A, Alsayed, A. R. Maqbali, et al. Investigating the human rhinovirus co-infection in patients with asthma exacerbations and COVID-19. Pharm Pract (Granada) .2022;20(2):2665. https://doi.org/10.18549/pharmpract.2022.2.2665
6. Kwah, J. H, Peters A. T. Asthma in adults: Principles of treatment. Allergy Asthma Proc.2019;40(6): 396-402. https://doi. org/10.2500/aap.2019.40.4256
7. Fergeson J. E, Patel S. S, Lockey R. F. Acute asthma, prognosis, and treatment. J Allergy Clin Immunol. 2017;139(2):438-447. https://doi.org/10.1016/j.jaci.2016.06.054
8. Basheti I. A, Obeidat N. M, Reddel H. K. Inhaler technique education and asthma control among patients hospitalized for asthma in Jordan. Saudi Pharm J. 2018;26(8):1127-1136. https://doi.org/10.1016/j.jsps.2018.06.002. Epub 2018 Jul 7
9. Rehman A,Amin F, Sadeeqa S. Prevalence of asthma and its management: A review. J Pak Med Assoc. 2018;68(12):1823-1827.
10. Castillo J. R, Peters S. P, Busse W. W. Asthma Exacerbations: Pathogenesis, Prevention, and Treatment. J Allergy Clin Immunol Pract. 2017;5(4):918-927. https://doi.org/10.1016/j.jaip.2017.05.001
11. Nour A, Alsayed A. R, Basheti I. Prevalence of Asthma amongst Schoolchildren in Jordan and Staff Readiness to Help. Healthcare (Basel). 2023;11(2). https://doi.org/10.3390/healthcare11020183
12. Basheti I. A, Salhi Y. B, Basheti M. M, et al. Role of the pharmacist in improving inhaler technique and asthma management in rural areas in Jordan. Clin Pharmacol. 2019;11:103-116. https://doi.org/10.2147/cpaa.s213271
13. Qunaibi E, Basheti I. A, Hamadi S. A, et al. Effect of Divergence in Patients’ Socioeconomic Background on their Perspective of the Role of the Community Pharmacist in Amman, Jordan. Trop J Pharm Res. 2013;12(2):247-253. https://doi.org/10.18549/ pharmpract.2022.1.2618
14. Khader H, Alsayed A, Hasoun L. Z, et al. Pharmaceutical care and telemedicine during COVID-19: A cross-sectional study based on pharmacy students, pharmacists, and physicians in Jordan. Pharmacia. 2022;69(3):891-901.
15. Alsayed A. R, Halloush S, Hasoun L, et al. Perspectives of the community in the developing countries toward telemedicine and pharmaceutical care during the COVID-19 pandemic. Pharm Pract (Granada). 2022;20(1):2618. https://doi.org/10.18549/ pharmpract.2022.1.2618
16. Basheti I. A, Bosnic-Anticevich S. Z, Armour C. L, et al. Checklists for powder inhaler technique: a review and recommendations. Respir Care. 2014;59 (7):1140-54. https://doi.org/10.4187/respcare.02342
17. Bosnic-Anticevich S. Z, Sinha H, So S, et al. Metered-dose inhaler technique: the effect of two educational interventions delivered in community pharmacy over time. J Asthma. 2010;47(3):251-6. https://doi.org/10.3109/02770900903580843
18. Basheti I. A, Bosnic-Anticevich S. Z, Armour C. L, et al. Checklists for Powder Inhaler Technique: A Review and Recommendations. Respir Care.2014;59(7):1140-1154. https://doi.org/10.4187/respcare.02342
19. Bosnic-Anticevich S. Z, Sinha H, So S, et al. Metered-dose inhaler technique: the effect of two educational interventions delivered in community pharmacy over time. J Asthma. 2010;47(3):251-6. https://doi.org/10.3109/02770900903580843
20. van der Palen J, Klein J. J, Schildkamp A. M. Comparison of a new multidose powder inhaler (Diskus/Accuhaler) and the Turbuhaler regarding preference and ease of use. J Asthma.1998;35(2):147-52. https://doi.org/10.3109/02770909809068202
21. Basheti I. A, Reddel H. K, Armour C. L, et al. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol.2007;119(6):1537-8. https://pubmed.ncbi.nlm.nih.gov/17433831/
22. Global Initiative for Asthma (GINA) - Global strategy for asthma management and prevention 2014 [May 2014], Available online at: http://www.ginasthma.org. Accessed September 2014.
23. Schatz M, Zeiger R. S, Yang S. J, et al. Development and preliminary validation of the Adult Asthma Adherence Questionnaire™.J Allergy Clin Immunol Pract.2013;1(3):280-8. https://doi.org/10.1016/j.jaip.2013.03.001
24. Ehteshami-Afshar S, FitzGerald J. M, Doyle-Waters M. M, et al. The global economic burden of asthma and chronic obstructive pulmonary disease. Int J Tuberc Lung Dis.2016;20(1):11-23. https://doi.org/10.5588/ijtld.15.0472
25. Loftus P. A, Wise S. K. Epidemiology and economic burden of asthma. Int Forum Allergy Rhinol. 2015; 5(1):S7-10. https://doi. org/10.1002/alr.21547
26. Ismaila A. S, Sayani A. P, Marin M, et al. Clinical, economic, and humanistic burden of asthma in Canada: a systematic review. BMC Pulm Med. 2013;13:70. https://doi.org/10.1186/1471-2466-13-70
27. Mäkelä M. J, Backer V, Hedegaard M, et al. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med.2013;107(10):1481-90. https://pubmed.ncbi.nlm.nih.gov/23643487/
28. George, M., Adherence in Asthma and COPD: New Strategies for an Old Problem. Respir Care.2018; 63(6):818-831. https:// doi.org/10.4187/respcare.05905
29. Busse W. W, Abbott C. B, Germain G, et al. Adherence and Persistence to Single-Inhaler Versus Multiple-Inhaler Triple Therapy for Asthma Management. J Allergy Clin Immunol Pract. 2022;10(11): 2904-2913.e6. https://doi.org/10.1016/j.jaip.2022.06.010
30. Newman S. P. Drug delivery to the lungs: challenges and opportunities. Ther Deliv.2017;8(8):647-661. https://doi.org/10.4155/ tde-2017-0037
31. Borgström L, Asking L, Thorsson L. Idealhalers or realhalers? A comparison of Diskus and Turbuhaler. Int J Clin Pract.2005;59(12):1488-95. https://doi.org/10.1111/j.1368-5031.2005.00747.x
32. Klijn S. L, Hiligsmann M, Evers S, et al. Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: a systematic review. NPJ Prim Care Respir Med. 2017;27(1):24. https://doi.org/10.1038/s41533- 017-0022-1
33. Hilton S. An audit of inhaler technique among asthma patients of 34 general practitioners. Br J Gen Pract 1990;40(341):505-6. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1371448/
34. Jones T. L, Neville D. M, Chauhan A. J. Diagnosis and treatment of severe asthma: a phenotype-based approach. Clin Med (Lond) .2018;18(2): s36-s40. https://doi.org/10.7861/clinmedicine.18-2-s36
35. Sanchis J, Gich I, Pedersen S. Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time? .Chest .2016;50(2):394-406. https://doi.org/10.1016/j.chest.2016.03.041
36. Basheti I. A, Qunaibi E, Bosnic-Anticevich S. Z, et al. User error with Diskus and Turbuhaler by asthma patients and pharmacists in Jordan and Australia. Respir Care. 2011;56(12):1916-23. https://doi.org/10.4187/respcare.01205
37. Nguyen Y. B. N, Wainwright C, Basheti I. A, et al. Do health professionals on respiratory wards know how to use inhalers?. J Pharm Pract Res. 2010;40(3):211-216.
38. Basheti I. A, Armour C. L, Reddel H. K, et al. Long-term maintenance of pharmacists’ inhaler technique demonstration skills. Am J Pharm Educ.2009;73(2):32. https://doi.org/10.5688/aj730232

Most read articles by the same author(s)