Associations of Correct Use of Inhalers, Medication Adherence, and Ability to Control Asthma

Main Article Content

Nisanat Nanual
Sanguan Lerkiatbundit
Woranuch Saengcharoen


Uncontrolled asthma incurs high cost of disease management and dramatically reduces patients’ quality of life. The objectives of this study were to examine associations of correct use of inhalers, medication adherence, and ability to control asthma in patients with asthma using inhaled corticosteroids. Methods: A survey study was conducted in 133 asthmatic patients. Pharmacists evaluated inhaler use by grading all steps of inhaler techniques and only key steps, inhaler adherence, asthma control, and emergency room visits for acute exacerbations in the months 0 and 6. Results: Correct use of inhalers in all steps was significantly related to predict medication adherence in the future (months 6) (P = 0.012). For correct use of inhalers in all steps and medication adherence (months 0) associated with asthma control in the same period (months 0) (OR 1.05; P = 0.040 and OR 1.06; P < 0.001, respectively) and significantly associated to predict in the future (months 6) (OR 1.05; P = 0.026 and OR 1.07; P < 0.001, respectively). In addition, correct use of inhalers in all steps and medication adherence (months 0) associated with acute asthma emergency room visits in the same period (months 0) (OR 0.01; P = 0.025 and OR 0.95; P = 0.002, respectively) and significantly related to predict in the future (months 6) (OR 0.01; P = 0.011 and OR 0.94; P < 0.001, respectively). Conclusion: The correct use of inhalers and medication adherence associated with asthma control and acute asthma emergency room visits in the same period and over the next 6 months. Therefore, the correct use of inhalers and medication adherence are important in patients with asthma, which should be continuously care by healthcare professionals.


Download data is not yet available.

Article Details

Pharmaceutical Practice


Arpibanwana S, Wattanakitkrileart D, Pongthavornkamol K, Dejsomritrutai W. Factors influencing disease control in patients with asthma. J Nurs Sci 2018; 36(4): 39-51.

Azzi E, Srour P, Armour C, Rand C, Bosnic-Anticevich S. Practice makes perfect: self-reported adherence a positive marker of inhaler technique maintenance. NPJ Prim Care Respir Med 2017; 27: 1-6.

Baraket M, Oliver B, Burgess JK, Lim S, King GG, Black JL. Is low dose inhaled corticosteroid therapy as effective for inflammation and remodeling in asthma? a randomized, parallel group study. Respir Res 2012; 13(1): 1-11.

Barnes CB, Ulrik CS. Asthma and adherence to inhaled corticosteroids: current status and future perspectives. Respir Care 2015; 60(3): 455-468.

Basheti IA, Qunaibi E, Bosnic-Anticevich SZ, Armour CL, Khater S, Omar M, et al. User error with Diskus and Turbuhaler by asthma patients and pharmacists in Jordan and Australia. Respir Care 2011; 56(12): 1916-1923.

Boven JFM, Koponen M, Lalic S, George J, Bell SJ, Hew M, et al. Trajectory analyses of adherence patterns in a real-life moderate to severe asthma population. J Allergy Clin Immunol Pract 2020; 8(6): 1961-1969.

Capanoglu M, Misirlioglu ED, Toyran M, Civelek E, Kocabas CN. Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children with asthma using metered dose or dry powder inhalers. J Asthma 2015; 52(8): 838-845.

Capstick TG, Azeez NF, Deakin G, Goddard A, Goddard D, Clifton IJ. Ward based inhaler technique service reduces exacerbations of asthma and COPD. Respir Med 2021; 187: 106583.

Chokhani R, Razak A, Waked M, Naing W, Bakhatar A, Khorani U, et al. Knowledge, practice pattern and attitude toward asthma management amongst physicians from Nepal, Malaysia, Lebanon, Myanmar and Morocco. J Asthma 2021; 58(7): 979-989.

Denton E, Bondarenko J, O'Hehir RE, Hew M. Breathing pattern disorder in difficult asthma: characteristics and improvement in asthma control and quality of life after breathing re-training. Allergy 2019; 74: 201-203.

Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MC, Verhamme KM. Medication adherence and the risk of severe asthma exacerbations: a systematic review. Eur Respir J 2015; 45: 396-407.

Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39(2): 175-191.

Gautier C, Charpin D. Environmental triggers and avoidance in the management of asthma. J Asthma Allergy 2017; 10: 47–56.

Gebremariam TH, Binegdie AB, Mitiku AS, Ashagrie AW, Gebrehiwot KG, Huluka DK, et al. Level of asthma control and risk factors for poor asthma control among clinic patients seen at a referral hospital in Addis Ababa, Ethiopia. BMC Res Notes 2017; 10: 1-6.

Gelzer AD, Gao W, Keleti D, Donia T, Megargell L, Kreitman J, et al. Multifaceted interventions improve medication adherence and reduce acute hospitalization rates in medicaid patients prescribed asthma controllers. J Asthma 2019; 56(2): 190-199.

Ghanname I, Chaker A, Hassani AC, Herrak L, Ebongue SA, Laine M, et al. Factors associated with asthma control: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco). BMC Pulm Med 2018; 18(1): 1-13.

Giraud V, Allaert FA, Roche N. Inhaler technique and asthma: feasability and acceptability of training by pharmacists. Respir Med 2011; 105(12): 1815-1822.

Global Initiative for Asthma. Global strategy for asthma management and prevention update 2022 [Internet]. 2022[cited 2022 May 29]. Available from:

Henry C, Audibert R, Keller M, Quaglia B, Vecellio L, Roche N. Real-life inhaler adherence and technique: time to get smarter!. Respir Med 2019; 158: 24-32.

Jaakkola MS, Aalto SAM, Hyrkas-Palmu H, Jaakkola JJK, Association between regular exercise and asthma control among adults: the population-based northern finnish asthma study. PLoS One 2020; 15(1): e0227983.

Kebede B, Mamo G, Molla A. Association of asthma control and metered-dose inhaler use technique among adult asthmatic patients attending outpatient clinic, in resource-limited country: a prospective study. Can Respir J 2019; 2019: 1-6.

Kenyon N, Zeki AA, Albertson TE, Louie S. Definition of critical asthma syndromes. Clin Rev Allergy Immunol 2015; 48: 1-6.

Khdour MR, Elyan SO, Hallak HO, Jarab AS, Mukattash TL, Astal A. Pharmaceutical care for adult asthma patients: A controlled intervention one-year follow-up study. Basic Clin Pharmacol Toxicol 2020; 126(4): 332-340.

Koya T, Hasegawa T, Takasawa J, Yoshimine F, Sakagami T, Hayashi M, et al. Influence of adherence to inhaled corticosteroids and inhaler handling errors on asthma control in a japanese population. Intern Med 2018; 57(23): 3357-3363.

Manavathongchai M, Jaruchanapongtorn T, Suwan P. Prevalence and risk factors of incorrect inhaler technique in asthmatic children at faculty of medicine Vajira hospital. Vajira Med J 2018; 62(5): 345-356.

Nittala A, Nahmens I, Ikuma L, Thomas D. Effects of medication adherence on healthcare services use among asthma patients. J Healthc Qual Res 2019; 34(6): 301-307.

Nwaru BI, Ekstrom M, Hasvold P, Wiklund F, Telg G, Janson C. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J 2020; 55(4): 1-11.

Padmanabhan M, Tamilarasu K, Rajaram M, Batmanabane G. Inadequate inhaler technique, an everlasting problem, is associated with poor disease control-a cross sectional study. Adv Respir Med 2019; 87(4): 217-225.

Russell RJ, Brightling C. Pathogenesis of asthma: implications for precision medicine. Clin Sci (Lond) 2017; 131(14): 1723-1735.

Sabate E, editor. Adherence to Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.

Songmuang A, Songmuang T. Outcomes of pharmaceutical care by SMART AsthCOPD application program to care asthma patients. Srinagarind Med J 2021; 36(5): 577-585.

Thai Asthma Council. Thai asthma guideline in adults 2019. Nonthaburi: Beyond Enterprise; 2018.

Treyaprasert W. Tips and pitfalls in asthma devices use [Online]. 2015 Aug 28 [cited 2020 Jan 18]. Available from:

Wanichwatphibun D. Problems with inhalation technique. Thai J Tuberc Chest 2018; 37: 52-55.