Clinical profile, inhaler technique, and predictors of inhaler adherence among asthma and COPD patients who attended the outpatient emergency department for acute exacerbation

Understanding the patients’ clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence amon...

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Published in:	Internal and emergency medicine Vol. 20; no. 6; pp. 1909 - 1916
Main Authors:	Koh, Hock Peng, Teoh, Paula Suen Suen, Roslan, Nurul Liana
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01.09.2025 Springer Nature B.V
Subjects:	Administration, Inhalation Adult Age Aged Asthma Asthma - drug therapy Asthma - psychology Chronic obstructive pulmonary disease Counseling Cross-Sectional Studies Data analysis Data collection EM - Original Emergency medical care Emergency Service, Hospital - organization & administration Emergency Service, Hospital - statistics & numerical data Female Hospitals Humans Inhalers Internal Medicine Lung diseases Male Medication Adherence - psychology Medicine Medicine & Public Health Middle Aged Mortality Nebulizers and Vaporizers - standards Nebulizers and Vaporizers - statistics & numerical data Patient compliance Patients Prospective Studies Pulmonary Disease, Chronic Obstructive - drug therapy Pulmonary Disease, Chronic Obstructive - psychology Regression analysis Respiratory diseases Malaysia Inhaler adherence Emergency Department Inhaler technique Asthma COPD
ISSN:	1828-0447, 1970-9366, 1970-9366
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Abstract	Understanding the patients’ clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients ( n = 85, 70.8%). Most were on regular follow-up ( n = 72, 60.0%) and adhered to their inhaler(s) ( n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly ( n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers’ mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.
AbstractList	Understanding the patients’ clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients (n = 85, 70.8%). Most were on regular follow-up (n = 72, 60.0%) and adhered to their inhaler(s) (n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly (n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers’ mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial. Understanding the patients’ clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients ( n = 85, 70.8%). Most were on regular follow-up ( n = 72, 60.0%) and adhered to their inhaler(s) ( n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly ( n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers’ mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial. Understanding the patients' clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients (n = 85, 70.8%). Most were on regular follow-up (n = 72, 60.0%) and adhered to their inhaler(s) (n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly (n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers' mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.Understanding the patients' clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients (n = 85, 70.8%). Most were on regular follow-up (n = 72, 60.0%) and adhered to their inhaler(s) (n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly (n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers' mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.
Author	Koh, Hock Peng Teoh, Paula Suen Suen Roslan, Nurul Liana
Author_xml	– sequence: 1 givenname: Hock Peng orcidid: 0000-0003-2676-7755 surname: Koh fullname: Koh, Hock Peng email: wilsonkoh821@gmail.com organization: Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health – sequence: 2 givenname: Paula Suen Suen surname: Teoh fullname: Teoh, Paula Suen Suen organization: Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health – sequence: 3 givenname: Nurul Liana surname: Roslan fullname: Roslan, Nurul Liana organization: Emergency and Trauma Department, Hospital Kuala Lumpur, Ministry of Health
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SubjectTerms	Administration, Inhalation Adult Age Aged Asthma Asthma - drug therapy Asthma - psychology Chronic obstructive pulmonary disease Counseling Cross-Sectional Studies Data analysis Data collection EM - Original Emergency medical care Emergency Service, Hospital - organization & administration Emergency Service, Hospital - statistics & numerical data Female Hospitals Humans Inhalers Internal Medicine Lung diseases Male Medication Adherence - psychology Medicine Medicine & Public Health Middle Aged Mortality Nebulizers and Vaporizers - standards Nebulizers and Vaporizers - statistics & numerical data Patient compliance Patients Prospective Studies Pulmonary Disease, Chronic Obstructive - drug therapy Pulmonary Disease, Chronic Obstructive - psychology Regression analysis Respiratory diseases
Title	Clinical profile, inhaler technique, and predictors of inhaler adherence among asthma and COPD patients who attended the outpatient emergency department for acute exacerbation
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