ORIGINAL RESEARCHES 217 www.journals.viamedica.pl Address for correspondence: Manjulakshmi Padmanabhan, Department of Pharmacology JIPMER, Puducherry, India; e-mail: manjulakshmi.p@gmail.com DOI: 10.5603/ARM.2019.0036 Received: 16.04.2019 Copyright © 2019 PTChP ISSN 2451–4934 Manjulakshmi Padmanabhan, Kadhiravan Tamilarasu, Manju Rajaram, Gitanjali Batmanabane Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India Inadequate inhaler technique, an everlasting problem associated with poor disease control — a cross-sectional study Abstract 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 signifcance of correct use has to be reiterated. Key words: adults, asthma, chronic obstructive pulmonary disease, dry powder inhaler, spirometry Adv Respir Med. 2019; 87: 217–225 Introduction Bronchial asthma and chronic obstructive pulmonary disease (COPD) are the most com- mon chronic lung diseases. Globally, 1–8% of the population are affected by bronchial asthma [1] and about 11.7% of people are diagnosed with COPD [2]. In India, among adults, 2–12% are affected by asthma [1] and 6.5–7.7% by COPD [3]. Even though they form two distinct diseases with different pathophysiology, disease progression, prognosis and treatment options, they manifest with similar symptoms like cough, wheezing and shortness of breath. These two diseases are incurable, but managed sympto- matically using anti-inflammatory drugs and bronchodilators [4]. Inhalers have been in use for decades in the treatment of these chronic respiratory diseases. They are preferred over other dosage forms due to their local effect, immediate onset of action and reduced side effects. Unlike other dosage forms, inhalers require a proper technique to ensure appropriate dose delivery to the lungs. Dry powder inhalers (DPIs) are breath-actuated and require forceful inhalation for appropriate dose delivery to the lungs and need less hand-mouth coordination for actuation and inhalation unlike metered-dose inhalers (MDI) [5]. Holding the head in a chin up position and gargling after inhala- tion are also essential for proper drug delivery and the reduction of side effects [6]. The inhaler technique in the last four decades was a poor method among 31% of the patients using DPI,