RESUMO
Objective Patients with chronic respiratory diseases (CRD) like asthma and chronic obstructive pulmonary disease (COPD) experience significant morbidity and mortality. The patient's quality of life deteriorates with the progression of the disease. Pharmacological treatment focuses on reducing the symptoms. The psychological impact of the disease on the patient's quality of life is not assessed by all healthcare providers. There is limited knowledge about the patient's demographic and clinical factors affecting the quality of life in CRD patients and aspects hindering or influencing the management of disease in this population. Hence we aimed to conduct a qualitative study on patients with asthma or COPD to get a view of their knowledge about the disease, the problems they encounter in their day-to-day life and the treatment. Methods Semi-structured, face-to-face interviews were conducted by the investigator in the hospital during the patient's follow-up visits. The questions focused on the patient's awareness of the disease, living with chronic respiratory disease, understanding of disease and treatment, and compliance with inhaled therapy. The interviews were audio recorded and transcribed verbatim. Content analysis of the data was done manually. Codes and themes were derived manually. Themes were formed from the codes and sub-themes. Results Five themes were generated from the data obtained: (1) misconceptions regarding the contagious nature of the disease; (2) psychological stress due to feelings of worthlessness, helplessness due to inability to work and poor understanding among family members; (3) inappropriate lifestyle modifications like avoiding fruits and vegetables due to the fear of acute attacks; (4) poor adherence to inhalers due to work timing and difficulty travelling; and (5) lack of reinforcement by the healthcare providers on inhaler technique and adherence were identified as causes of poor inhaler technique and inappropriate knowledge about drugs. Conclusion Subjective reporting by patients in this study was helpful in understanding issues concerning disease management in CRD patients. Apart from assessing the patients' symptoms and prescribing drugs, healthcare providers should take time to impart knowledge about the disease to patients. Though patient education and psychological intervention are challenging to implement daily, they are supplemental to the pharmacologic management of the disease.
RESUMO
INTRODUCTION: Dry powder inhalers (DPI) have been in use in the treatment of chronic respiratory diseases for decades. DPIs require proper inhaler technique to ensure appropriate dose delivery to the lungs which in turn provides disease control and hence reduces the economic burden due to frequent acute attacks and hospital visits. Inadequate inhaler technique remains an everlasting problem among patients with chronic respiratory disease. Hence the aim is to assess the inhaler technique in patients using DPI and to determine the factors associated with inhaler technique. MATERIAL AND METHODS: A cross-sectional study was conducted and 385 patients with asthma or chronic obstructive pulmonary disease (COPD) were recruited. Patient-related and disease-related factors were noted. Severity of the disease were assessed using asthma control test/COPD assessment test questionnaire and spirometer. The investigator assessed the inhaler technique of the patient against standard checklist. RESULTS: Nearly 46.2% of the patients performed incorrect inhaler technique. Multivariate analysis showed factors like young age [Odd's ratio (OR) 4.13, CI 1.31-17.8], well controlled disease (OR 2, CI 1.1-3.65), and the patients who learnt the technique from a medical personnel (OR 3.67, CI 1.46-9.24) had better inhaler technique. CONCLUSION: This study shows that the proper use of inhaler is still an unattained goal and significance of correct use has to be reiterated.
