Evaluation of inhaler use skills of patients diagnozed with chronic obstructive pulmonary disease (COPD) in primary care: The example of samsun province

Aim: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of morbidity and mortality worldwide, and is a chronic disease that poses a serious burden not only in terms of individual health but also in economic and social aspects. Our aim is to analyze the inhaler usage skills of patients who were followed up in primary health care institutions in Samsun province and who were previously diagnosed with COPD and started on inhaler treatment, and the sociodemographic and clinical factors associated with these skills. Materials and methods: Our study is a descriptive, cross-sectional, survey study. The universe of our study consists of patients with COPD (ICD J44.0-9) who reside in Samsun province and are followed up in primary health care centers. 158 family health centers in Samsun city center and 9 districts were visited. The ability of 384 patients who met the research acceptance criteria and agreed to participate in the study to apply an inhaler device was examined. A face-to-face survey was applied to the participants, including questions about their sociodemographic information and inhaler treatments. Results: In the study, 72.4% (n=278) of the 384 patients were male. The mean age of the participants was found to be 62.4±13.9 years. When the general inhaler usage skills were examined, it was determined that a significant portion of COPD patients could not use the devices adequately. The highest adequacy rate (93.1%) was observed in single-dose dry powder inhaler (DPI) users, while the lowest rates were seen in Ellipta (46.8%) and metered dose inhaler (MDI) (48.1%) users. Statistically significant differences were found between age groups and inhaler device usage skills for some device types. In particular, MDI (p < 0.001), Diskus (p = 0.002), Turbuhaler (p = 0.008) and Ellipta (p = 0.027) users, usage skills decreased with age; a significant decrease was observed especially in the 80 years and older group. In our study, statistically significant differences were found between education status and inhaler device usage skills, especially for some devices. It was determined that as the level of education increases in MDI (p < 0.001), Diskus (p < 0.001), Turbuhaler (p = 0.004) and Ellipta (p = 0.024) users, the rate of sufficient usage skill also increases. According to the findings, place of residence stands out as a significant variable on the device usage skill. Especially in MDI (p < 0.001), Diskus (p = 0.002) and Turbuhaler (p = 0.003) users, it was determined that individuals living in urban areas used the device with a more accurate and sufficient technique compared to those living in rural 9 areas. According to the findings, it was determined that especially in MDI (p < 0.001), Diskus (p = 0.001) and Turbuhaler (p = 0.002) users, the usage skill of individuals who have been using the device for a long time was significantly higher. Although 92.7% of the patients had their inhaler prescribed by their family physician, only 31.2% of them consulted their family physician regarding usage problems. The strongest factors affecting the adequacy of pMDI use were found to be: being in the 40-59 age group, using inhalers regularly and having a long-standing disease in some devices (Odds Ratio = 3.3, p < 0.001), (Odds Ratio = 2.3, p = 0.010), (Odds Ratio = 2.2, p < 0.001). Individuals who use PMDI devices regularly and individuals in the 40-59 age group have a significant advantage in reaching the adequacy level (Odds Ratio = 3.1; p < 0.001), (Odds Ratio = 2.2, p = 0.045). Individuals in the 40–59 age group, regular inhaler use, and disease duration of 36 months or more are important factors in achieving a sufficient level of Diskus use skill (Odds Ratio = 2.5; 95% CI: 1.4 – 4.5; p = 0.003), (Odds Ratio = 2.7; 95% CI: 1.5 – 5.1; p = 0.002), (Odds Ratio = 4.9, p = 0.003). Conclusion: It has been determined that patients experience various levels of inadequacy in the use of inhaler devices, and that error rates are high, especially in technical steps related to breathing. Although the majority of patients receive their first inhaler device training from a healthcare professional, the high rate of usage errors suggests that healthcare professionals should be careful about patient education and that this training should be repeated at certain intervals. Although most patients have their inhaler medications prescribed by their family physicians, the rate of consulting their family physicians for problems related to the use of the device is low. This situation indicates that inhaler training should be strengthened in primary healthcare service Keywords: COPD, Inhaler, Family Medicine