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1 Dept of Respiratory Medicine, University of Paris René Descartes, Ambroise Paré Hospital, Boulogne, 2 Dept of Respiratory and Intensive Care Medicine, University of Paris Pierre et Marie Curie, Hôtel Dieu Hospital, Paris, France
CORRESPONDENCE: V. Giraud, Université de Paris René Descartes, Service de Pneumologie, Hôpital A. Paré, 9 Avenue Charles de Gaulle, F-92104, Boulogne Cédex, France. Fax: 33 149095801
Keywords: asthma control, inhaled corticosteroids, metered-dose inhaler, misuse, poor coordination
Received: February 22, 2001
Accepted August 9, 2001
This work was supported in part by a grant from 3M Pharma, Cergy, France.
This study assessed whether the improper use of pressurized metered-dose inhalers (pMDIs) is associated with decreased asthma control in asthmatics treated by inhaled corticosteroids (ICS).
General practitioners (GPs) included consecutive asthmatic outpatients treated by pMDI-administered ICS and on-demand, short-acting ß2-agonists. They measured an asthma instability score (AIS) based on daytime and nocturnal symptoms, exercise-induced dyspnoea, ß2-agonist usage, emergency-care visits and global perception of asthma control within the preceding month; the inhalation technique of the patient also was assessed.
GPs (n=915) included 4,078 adult asthmatics; 3,955 questionnaires were evaluable. pMDI was misused by 71% of patients, of which 47% was due to poor coordination. Asthma was less stable in pMDI misusers than in good users (AIS: 3.93 versus 2.86, p<0.001). Among misusers, asthma was less stable in poor coordinators (AIS: 4.38 versus 3.56 in good coordinators, p<0.001).
To conclude, misuse of pressurized metered-dose inhalers, which is mainly due to poor coordination, is frequent and associated with poorer asthma control in inhaled corticosteroid-treated asthmatics. This study highlights the importance of evaluating inhalation technique and providing appropriate education in all patients, especially before increasing inhaled corticosteroid dosage or adding other agents. The use of devices which alleviate coordination problems should be reinforced in pressurized metered-dose inhaler misusers.
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