Effect of counseling on inhalation technique of metered-dose inhaler alone and with MDI PLUS or AeroChamber2go

OBJECTIVE This study aimed to measure the impact of repeated counselling on asthma control and inhaler technique using pressurized metered-dose inhaler (pMDI) alone and in combination with pMDI PLUS® (cardboard-based spacer) or AeroChamber2go® in adult asthma patients.

METHODS This is a prospective randomized clinical trial in which a cohort of 300 asthma patients was randomly allocated into three equal groups (n = 100): (1) pMDI alone, (2) pMDI + MDI PLUS®, and (3) pMDI + AeroChamber2go®. The patient groups were interviewed to assess the inhalation technique of the three devices, in parallel, upon three monthly separate visits. At baseline and during two subsequent monthly visits, each group received three standardized training sessions. Before each session, patients performed the inhalation steps with their assigned device, and the number of technical errors was recorded. Lung function (Forced Expiratory Volume in one second (FEV1) % of predicted, Peak Expiratory Flow (PEF) % of predicted) and Asthma Control Test (ACT) scores were also assessed.

RESULTS At the first visit, MDI PLUS®, and AeroChamber2go® groups made significantly fewer inhalation errors than the pMDI alone group (p = 0.04, and p = 0.041, respectively). Error rates with pMDI alone only decreased significantly by the third visit (p = 0.04). Throughout all visits, MDI PLUS® consistently showed fewer errors than AeroChamber2go®, although this difference did not reach statistical significance (p > 0.05). Regarding clinical outcomes, both spacer groups experienced significant, visit-to-visit improvements in FEV1% of predicted, PEF% of predicted, and ACT scores (all p < 0.05 between visit 1 and 2 and between visit 2 and 3). In contrast, the pMDI alone group showed no significant change between visits 1 and 2, with statistically significant improvement only by visit 3 (FEV1, p = 0.04; PEF, p = 0.03; ACT, p = 0.04).

CONCLUSION Counseling asthmatic patients with either spacer has significantly reduced inhalation errors and provided greater and earlier improvements in terms of lung function and asthma control compared to pMDI alone.