RESULTS1) Graph 1 – Bar diagram showing age and sex wise distribution of study sample.
Age (years)Mean 55.80Std. Error of Mean 1.581Std. Deviation 15.81Range 69Minimum 16Maximum 85Mean age of study sample is 55.8 years with standard deviation of 15.
81 years, with the highest 85 yrs and lowest 16 years. There were 71 (71%) males and 29 (29%) females in the study. 36 samples were from 61-75 years age group followed by 33 subjects in 46-60 years age group. No significant difference was observed between mean ages ofgender (p = 0.143). 2) Pie chart showing frequency distribution according diagnosis.
There were 51 (51%) bronchial asthma subjects among study samples, while 49 (49%) were having COPD.3) Pie chart showing frequency distribution of study sample according to smoking history.Above pie chart shows that, there history was smoking was present in more COPD Subjects (61%) than bronchial asthma subjects (31%). There was association between smoking history and diagnosis of subjects (p = 0.003). 4) Pie chart showing frequency distribution of study sample according to inhalation device used.There were 32 (32%) study samples using DPI single dose inhalation device, followed by 31(31%) PMDI device.
30 (30%) were using PMDI with spacer while 7 (7%) were using DPI multi dose inhalation device.5) Bar diagram showing method of instruction given touse inhalation device.Above bar diagram shows that, demonstration was given in 53 (53%) subjects regarding inhalation technique, while in 47 (47%) subjects verbal instructions were given. Demonstration was required more in PMDI with spacer & DPI multi dose, while verbal instructions required more in DPI single dose & PMDI.Mode of Instruction Incorrect Steps Correct Steps Marginal Row Total Verbal 146 241 387Demonstration 101 336 437Marginal Column totals 247 577824 (Grand Total)Chi square test result shows that, less the mistake done when instruction mode was Demonstration than Verbal . There was significant difference between the modes of instruction and the result of steps of Inhalation(correct/incorrect), difference was statistically highly significant.
P value is =0.000005.The result is significant at P <0.056) Bar diagram showing distribution according to instructor of inhalation technique.Above bar diagram shows that, Mostly chest physician (22%) was instructor in PMID with spacer while General Practioner (22%) was mostly the instructor in DPI single dose. 7) Bar diagram showing method of instruction given touse inhalation device.Bar diagram shows that, Demonstration method of instruction was more preferred by chest physician than verbal method.
While General Practioner and physicians preferred verbal method of instruction regarding use of device.8) Table showing frequency of inhalation technique steps(Correct/Incorrect) with respect to instructor of inhalation devices in study samples.Instructor Incorrect Steps Correct Steps Row TotalChest Physician 58 256 314General Practitioner 99 189 288Physician 90 132 222Column Total 247 577 824(Grand Total)Chi square test result shows that, less the mistake was done by chest physician instructed subjects, than General Practitioner & Physician. There was significant difference between instructor and result of steps of inhalation, difference was statistically highly significant. P value is <0.00001.
The result is significant at P<0.059) Table showing frequency of inhalation technique steps with respect to inhalation devices followed in study sampleStep Interpretation DPI Multi Dose DPI Single Dose PMDI PMDI with Spacer Total Remove Cap/Cover Correct 7 32 31 30 100Shake the Inhaler Correct 0 0 15 20 35Not Correct 0 0 16 10 26Not Included 7 32 0 0 39Insert inhaler in spacer Correct 0 0 0 27 27Not Correct 0 0 0 3 3Not Included 7 32 31 0 70Place of Capsule in chamber Correct 0 31 0 0 31Not Correct 0 1 0 0 1Not Included 7 0 31 30 68Press the spike button Correct 0 28 0 0 28Not Correct 0 4 0 0 4Not Included 7 0 31 30 68Load the drug by pressing lever/twisting grip around till click heard Correct 4 0 0 0 4Not Correct 3 0 0 0 3Not Included 0 32 31 30 94Exhale before inhaling Correct 4 8 12 18 42Not Correct 3 24 19 12 58Place the mouthpiece between teeth without gap Correct 7 27 26 27 87Not Correct 0 5 5 3 13Breath in deeply after loading drug/Inhaler dose in the spacer Correct 5 20 0 17 42Not Correct 2 12 0 13 27Not Included 0 0 31 0 31Breath in & release 1 dose simultaneously by pressing canister Correct 0 0 8 0 8Not Correct 0 0 23 0 23Not Included 7 32 0 30 69Breadth Hold Correct 4 6 15 14 39Not Correct 3 26 16 16 61Exhale in spacer, inhale &Hold breath again Correct 0 0 0 20 20Not Correct 0 0 0 10 10Not Included 7 32 31 0 70Remove the inhaler and Breath out Correct 7 29 26 30 92Not Correct 0 3 5 0 8Open to check leftover powder Correct 0 22 0 0 22Not Correct 0 10 0 0 10Not Included 7 0 31 30 68Out of the 100 subjects,the maximum mistakes committed which was common for all the devices was that 61(61%) subjects had short breath hold after inhaling the drug from device,while 2nd most common mistake was 58 subjects (58%)did not exhale to residual volume before inhaling the drug.In the PMDI devices with or without spacer ,32 subjects(52.45%) of subjects had short breadth hold while second most common error was not exhaling before inhaling in 31 subjects (50.
81%).The third and a major mistake was that 26(42.62%)Subjects didn’t shake the inhaler before use.
In PMDI devices without spacer the major issue was of hand breadth coordination where 23 subjects (74.19%)committed error and did not have proper coordination.It was followed by short breadth hold and not shaking the inhaler where in both steps 16(51.61%) subjects committed mistakes. In the PMDI with spacer ,16 subjects(53.33%) of subjects had short breadth hold while second most common error was unable to breathe in deeply from the spacer in 13subjects(43.33) and the third common error was not exhaling before inhaling in 12 subjects (40%).In DPI devices the maximum mistakes committed which was that 29(74.35%) subjects had short breath hold after inhaling the drug from device, while 2nd most common mistake was 27subjects (64.10%)did not exhale to residual volume before inhaling the drug.
