Metered-dose Inhaler Technique and Asthma Control in Patients Attending an Urgent Care Clinic in Barbados

Objective: To estimate the proportion of some Barbadian asthmatics with correct pressurised metered-dose inhaler (MDI) technique. Methods: All the asthmatics, 12 to 65 years of age, using a MDI and attending an urgent care clinic on selected clinic days over a five-month, period were administered a questionnaire and had their MDI technique evaluated. Results: Of the 148 respondents (response rate 99%), their median age was 27 years, 28% were males, 99% black; 87% had asthma for six or more years; 83% were using steroid inhalers, 24% were attending for treatment of an asthma attack and only 36% received routine non-urgent asthma care. Sixty-one per cent reported controlled asthma over the previous month, 97% felt that their MDI technique was good and 25% did not identify a healthcare worker as the source of their MDI technique education. Pharmacists almost never provide instructions. In the previous week, 47% had no asthma symptoms or need to use rescue inhalers and 63% had controlled asthma as determined by the asthma control questionnaire. Only 5% (95% confidence interval +/- 3.4) had correct MDI technique. All the patients had removed the cap, but only 41% shook the device, 56% actuated the inhaler only once, 11% coordinated actuation and inhalation correctly and 18% held their breath after inhalation. Conclusions: Few asthmatics had the correct MDI technique. Healthcare workers should use every opportunity to check and teach asthmatics the use of inhaler technique.