What question did this study set out to answer?

The study aims to evaluate the correctness of pressurized metered-dose inhaler (MDI) usage and identify predictors of errors among patients in a respiratory outpatient department.

April 29, 2026Open Access

Correct Use of Pressurized Metered-Dose Inhalers and Its Predictors among Patients Attending a Respiratory Medicine Outpatient Department in Eastern India

Key Points

The study aims to evaluate the correctness of pressurized metered-dose inhaler (MDI) usage and identify predictors of errors among patients in a respiratory outpatient department.
Cross-sectional study with purposive sampling of 115 patients aged >12 years using MDIs.
Assessment included observational checklists based on standard guidelines and critical steps for inhaler use.
Data analyzed using SPSS v20, with significance set at P < 0.05.
Only 14.8% of patients demonstrated correct MDI technique, while 85.2% made at least one critical error.
Key errors included inadequate breath-holding (59.2%), incomplete exhalation (53.9%), and poor coordination (29.6%).
Shorter duration of MDI use significantly predicted errors (median use 5.5 vs. 36 months, P = 0.043).

Abstract

Background: Incorrect use of pressurized metered-dose inhalers (MDIs) compromises drug delivery in asthma and chronic obstructive pulmonary disease (COPD) management, with global error rates up to 94%. This cross-sectional study evaluated MDI technique correctness and predictors among patients in a respiratory outpatient department in Eastern India, addressing a local research gap. Methods: Purposively sampled 115 patients aged >12 years using MDIs were assessed over 1 month, excluding severely ill cases, active tuberculosis, or interfering comorbidities. Observational checklists based on National Heart, Lung, and Blood Institute 2021 guidelines and Newman critical steps (shaking inhaler, full exhalation, actuation–inhalation coordination, ≥10-second breath-hold) were used during interviews with dummy inhalers. Sociodemographics, disease, and MDI variables were analyzed via SPSS v20 (means ± standard deviation, percentages, Mann–Whitney U , Fisher’s exact; P 0.05). Conclusion: With an 85.2% critical error rate, routine reinforcement of key MDI steps, especially for short-term users, rural, and low-SES patients, is essential to enhance respiratory outcomes.

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