Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Relation between patient characteristics and inhaler technique with asthma and COPD patients : A quantitative and qualitative, explorative study

(2017) Lieshout, M.T.

Background Asthma and COPD are two common lung diseases around the world. Both lung diseases show many similarities in symptoms, but the treatment and course of both diseases is different. Inhalation medication is the cornerstone in treatment of patients with asthma or COPD. However, many patients still have an incorrect inhaler technique. This keeps patients retain more complaints, medical expenses may be higher and it affects the quality of life. The purpose of this study is to investigate whether there are correlations between patient characteristics and a sufficient inhaler technique. Results can improve the treatment of asthma and COPD and education towards health care providers.
Methods The study consists of three study parts, all with the same purpose. First a quantitative study on an existing database was used to investigate different patient characteristics with a sufficient inhaler technique (n=8151). Second, two questionnaires were used to investigate whether there are differences in illness perception and self-efficacy in patients with sufficient and insufficient inhaler technique (Illness Perceptions Questionnaire IPQ-K and the Dutch General self-efficacy questionnaire) (n=83). Finally, a qualitative and explorative study was conducted with in-depth interviews in patients with a sufficient inhaler technique (n=12).
Results We found significant associations between baseline sufficient inhaler technique and female gender (38.9 versus 35.7, p=0.003), lower BMI (27.2 versus 27.6, p=0.010), younger age (50.6 versus 54.4, p<0.001) and younger age of onset (28.0 versus 27.6, p<0.001). Patients with asthma have a better inhaler technique compared to patients with COPD (39.4 versus 33.1, p<0.001). Also more exacerbations (46% versus 43%, p=0.002) and allergies (47% versus 44%, p=0.016) were found in the sufficient inhaler technique group. At follow-up, only significant associations were found in women (49.1% versus 41.7%, p=0.043).
Outcomes of the illness perceptions questionnaire showed that the illness perception among COPD patients with insufficient inhalation technique is lower than patients with asthma and insufficient inhaler technique. The interviews that were conducted support these results. Illness perceptions was during the interviews also very different. The self-efficacy questionnaire showed no differences.
The interviews showed that all participants have received an instruction about the inhaler technique, at least once. In addition, the vast majority used a method to remind themselves to take the inhalation medication.
Conclusion Learning a sufficient inhaler technique is still a problem. At follow-up, our database study showed that differences in age and diagnosis disappeared which leads to the conclusion that learning a sufficient inhaler technique does not depend on age or diagnosis such as asthma or COPD. In order to improve the inhaler technique, one might consider to pay attention to patient’s illness perceptions. More research is needed to improve inhalation instruction and inhaler technique. The results of this study can be used to improve education to care givers and to develop a good inhalation instruction for the future

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