Evaluation of Gender Differences of Inhalers Use and Training Needs among Chronic Obstructive Pulmonary Disease Patients in a Tertiary Care Hospital in Pakistan
Keywords:
COPD, MDI, Pakistan, Spacer, Gender Differences, Inhaler TechniqueAbstract
Background: Correct use of metered dose inhalers (MDIs) with spacers is crucial in the management of Chronic Obstructive Pulmonary Disease (COPD). Gender-based disparities in inhaler technique may influence treatment outcomes, particularly in low-resource settings. Objective: To compare metered dose inhaler technique and training needs between male and female COPD patients. Methodology: This descriptive cross-sectional study was conducted at the Pulmonology Unit, Khyber Teaching Hospital, Peshawar. A total of 140 COPD patients using MDIs with spacers were evaluated using a 9-step checklist. Patients were classified into proper, improper, or poor technique categories. Step-wise performance and receipt of prior guidance were assessed by gender. Chi-square tests were used to evaluate associations. Results: Out of 78 male and 62 female patients, proper technique was observed in 17.9% males and 16.1% females. Not-Poor technique was more frequent among females (83.9%) than males (28.2%). Although 94.3% of patients reported receiving guidance, female patients missed more critical steps (especially steps 2, 3, and 4). Gender had no statistically significant association with overall technique category (p = 0.216), but significant differences were noted in specific step performances. Conclusion: While overall technique did not differ significantly between genders, step-wise analysis reveals areas where female patients require enhanced training. Culturally sensitive and gender-focused educational strategies are recommended to optimize inhaler use and disease outcomes.References
Aung HA, Tan R, Flynn C, et al. Digital monitoring and intervention strategies for maintenance inhaler adherence in COPD: systematic review and meta-analysis. Thorax. 2024;79(Suppl 2):A291.
GOLD. Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2023 Report.
World Health Organization. Chronic obstructive pulmonary disease (COPD) fact sheet. 2022.
NICE. Chronic Obstructive Pulmonary Disease in Over 16s: Diagnosis and Management. NICE Guideline NG115. 2019.
Sarwar KA, Naseer U, Tabassum A, Naseer F. Assessment of inhalational technique of Metered‑dose Inhalers among its users in Pakistan. Pak J Chest Med. 2020;26(1):15‑21.
Muhammad A, Anjum A, Shabbir M, Basharat F. Evaluation of the inhaler technique and quality of life in patients with COPD: a tertiary care hospital study in Lahore. J Pak Med Assoc. 2021;71(6):1490–1495.
Ceyhan Y, Kartinsoy PT. The effects of breathing exercises and inhaler training on dyspnea and quality of life in COPD: a randomized controlled trial. Trials. 2022;23:707.
Ohbayashi H. Key points in effective inhaler technique training for asthma and COPD patients. Clin Surg Group. 2020;5(114).
Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930–938.
Rootmensen GN, van Keimpema AR, Jansen HM, de Haan RJ. Predictors of incorrect inhalation technique in patients with asthma or COPD. J Aerosol Med. 2006;19(4):417–424.
Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593–604.
Khan A, Zahid S, Nazir Z, Khalid S. Inhaler technique in patients with chronic respiratory illnesses in primary care settings of Pakistan: need for training. Pak J Med Health Sci. 2020;14(3):975–979.
Özmen İ. Influence of Gender on Inhaler Technique. Respir Care. 2020;65(4):431–437.
Rogliani P, Ritondo BL, Matera MG, Blasi F. Sex differences in adult asthma and COPD therapy: systematic review up to Jan 2022. Respir Res. 2022;23:222.
Ali S, Sohail H, Bibi A. Gender-based differences in COPD presentation and medication adherence in a semi-urban Pakistani population. Pak J Chest Med. 2022;28(1):5–10.
Jabeen S, Khan AA, Bhatti Z. Barriers to effective inhaler use in women with COPD in rural Pakistan. Pak J Public Health. 2023;13(2):80–84.
Whittaker H, Adamson A, Stone P, et al. Sex differences in asthma and COPD hospital admission, readmission and mortality in UK. BMJ Open Resp Res. 2025;12(1):e002808.
Paske R, van Dijk L, Linn AJ, et al. On TRACk: training and counselling intervention to improve inhaler technique and adherence; protocol of cluster RCT. BMJ Open. 2022;12(9):e061266.
Yousaf M, Siddiqui MA, Ahmad N, et al. Knowledge and practice of inhaler technique among COPD patients in a tertiary care hospital in Islamabad. J Ayub Med Coll Abbottabad. 2020;32(2):215–219.
Ghosh S, Williams DM, Pinto-Plata V, et al. Gender differences in COPD: impact on quality of life and clinical characteristics. Int J Chron Obstruct Pulmon Dis. 2020;15:2095–2105.
Aburahma MH, Mukattash TL, Alzoubi KH, et al. A comparison of dry powder inhaler technique between male and female COPD patients in Jordan. Int J Clin Pract. 2021;75(5):e13992.
Islam MS, Sharifuzzaman M, Rahman MA, et al. Assessment of inhaler technique among COPD patients in Bangladesh: gender perspective. Respir Med Case Rep. 2022;36:101570.
Farkas P, Kovacs G, Bajcsy A. Comparative study of inspiratory flow with different dry powder inhalers in COPD: gender and age considerations. Pulmonology. 2024 Feb;30(2):123–129.
Basheti IA, Armour CL, Reddel HK, Bosnic-Anticevich SZ. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007;119(6):1537–1538.
Malik MA, Awais SM, Iqbal M. Effectiveness of repeated training on inhaler technique in COPD patients attending a pulmonary clinic in Multan. Ann King Edward Med Univ. 2021;27(4):487–492.
Aung HA, Tan R, Flynn C, et al. Digital monitoring and intervention strategies for maintenance inhaler adherence in COPD: systematic review and meta-analysis. Thorax. 2024;79(Suppl 2):A291.
GOLD. Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2023 Report.
World Health Organization. Chronic obstructive pulmonary disease (COPD) fact sheet. 2022.
NICE. Chronic Obstructive Pulmonary Disease in Over 16s: Diagnosis and Management. NICE Guideline NG115. 2019.
Sarwar KA, Naseer U, Tabassum A, Naseer F. Assessment of inhalational technique of Metered‑dose Inhalers among its users in Pakistan. Pak J Chest Med. 2020;26(1):15‑21.
Muhammad A, Anjum A, Shabbir M, Basharat F. Evaluation of the inhaler technique and quality of life in patients with COPD: a tertiary care hospital study in Lahore. J Pak Med Assoc. 2021;71(6):1490–1495.
Ceyhan Y, Kartinsoy PT. The effects of breathing exercises and inhaler training on dyspnea and quality of life in COPD: a randomized controlled trial. Trials. 2022;23:707.
Ohbayashi H. Key points in effective inhaler technique training for asthma and COPD patients. Clin Surg Group. 2020;5(114).
Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930–938.
Rootmensen GN, van Keimpema AR, Jansen HM, de Haan RJ. Predictors of incorrect inhalation technique in patients with asthma or COPD. J Aerosol Med. 2006;19(4):417–424.
Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593–604.
Khan A, Zahid S, Nazir Z, Khalid S. Inhaler technique in patients with chronic respiratory illnesses in primary care settings of Pakistan: need for training. Pak J Med Health Sci. 2020;14(3):975–979.
Özmen İ. Influence of Gender on Inhaler Technique. Respir Care. 2020;65(4):431–437.
Rogliani P, Ritondo BL, Matera MG, Blasi F. Sex differences in adult asthma and COPD therapy: systematic review up to Jan 2022. Respir Res. 2022;23:222.
Ali S, Sohail H, Bibi A. Gender-based differences in COPD presentation and medication adherence in a semi-urban Pakistani population. Pak J Chest Med. 2022;28(1):5–10.
Jabeen S, Khan AA, Bhatti Z. Barriers to effective inhaler use in women with COPD in rural Pakistan. Pak J Public Health. 2023;13(2):80–84.
Whittaker H, Adamson A, Stone P, et al. Sex differences in asthma and COPD hospital admission, readmission and mortality in UK. BMJ Open Resp Res. 2025;12(1):e002808.
Paske R, van Dijk L, Linn AJ, et al. On TRACk: training and counselling intervention to improve inhaler technique and adherence; protocol of cluster RCT. BMJ Open. 2022;12(9):e061266.
Yousaf M, Siddiqui MA, Ahmad N, et al. Knowledge and practice of inhaler technique among COPD patients in a tertiary care hospital in Islamabad. J Ayub Med Coll Abbottabad. 2020;32(2):215–219.
Ghosh S, Williams DM, Pinto-Plata V, et al. Gender differences in COPD: impact on quality of life and clinical characteristics. Int J Chron Obstruct Pulmon Dis. 2020;15:2095–2105.
Aburahma MH, Mukattash TL, Alzoubi KH, et al. A comparison of dry powder inhaler technique between male and female COPD patients in Jordan. Int J Clin Pract. 2021;75(5):e13992.
Islam MS, Sharifuzzaman M, Rahman MA, et al. Assessment of inhaler technique among COPD patients in Bangladesh: gender perspective. Respir Med Case Rep. 2022;36:101570.
Farkas P, Kovacs G, Bajcsy A. Comparative study of inspiratory flow with different dry powder inhalers in COPD: gender and age considerations. Pulmonology. 2024 Feb;30(2):123–129.
Basheti IA, Armour CL, Reddel HK, Bosnic-Anticevich SZ. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007;119(6):1537–1538.
Malik MA, Awais SM, Iqbal M. Effectiveness of repeated training on inhaler technique in COPD patients attending a pulmonary clinic in Multan. Ann King Edward Med Univ. 2021;27(4):487–492.
Aung HA, Tan R, Flynn C, et al. Digital monitoring and intervention strategies for maintenance inhaler adherence in COPD: systematic review and meta-analysis. Thorax. 2024;79(Suppl 2):A291.
GOLD. Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2023 Report.
World Health Organization. Chronic obstructive pulmonary disease (COPD) fact sheet. 2022.
NICE. Chronic Obstructive Pulmonary Disease in Over 16s: Diagnosis and Management. NICE Guideline NG115. 2019.
Sarwar KA, Naseer U, Tabassum A, Naseer F. Assessment of inhalational technique of Metered‑dose Inhalers among its users in Pakistan. Pak J Chest Med. 2020;26(1):15‑21.
Muhammad A, Anjum A, Shabbir M, Basharat F. Evaluation of the inhaler technique and quality of life in patients with COPD: a tertiary care hospital study in Lahore. J Pak Med Assoc. 2021;71(6):1490–1495.
Ceyhan Y, Kartinsoy PT. The effects of breathing exercises and inhaler training on dyspnea and quality of life in COPD: a randomized controlled trial. Trials. 2022;23:707.
Ohbayashi H. Key points in effective inhaler technique training for asthma and COPD patients. Clin Surg Group. 2020;5(114).
Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930–938.
Rootmensen GN, van Keimpema AR, Jansen HM, de Haan RJ. Predictors of incorrect inhalation technique in patients with asthma or COPD. J Aerosol Med. 2006;19(4):417–424.
Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593–604.
Khan A, Zahid S, Nazir Z, Khalid S. Inhaler technique in patients with chronic respiratory illnesses in primary care settings of Pakistan: need for training. Pak J Med Health Sci. 2020;14(3):975–979.
Özmen İ. Influence of Gender on Inhaler Technique. Respir Care. 2020;65(4):431–437.
Rogliani P, Ritondo BL, Matera MG, Blasi F. Sex differences in adult asthma and COPD therapy: systematic review up to Jan 2022. Respir Res. 2022;23:222.
Ali S, Sohail H, Bibi A. Gender-based differences in COPD presentation and medication adherence in a semi-urban Pakistani population. Pak J Chest Med. 2022;28(1):5–10.
Jabeen S, Khan AA, Bhatti Z. Barriers to effective inhaler use in women with COPD in rural Pakistan. Pak J Public Health. 2023;13(2):80–84.
Whittaker H, Adamson A, Stone P, et al. Sex differences in asthma and COPD hospital admission, readmission and mortality in UK. BMJ Open Resp Res. 2025;12(1):e002808.
Paske R, van Dijk L, Linn AJ, et al. On TRACk: training and counselling intervention to improve inhaler technique and adherence; protocol of cluster RCT. BMJ Open. 2022;12(9):e061266.
Yousaf M, Siddiqui MA, Ahmad N, et al. Knowledge and practice of inhaler technique among COPD patients in a tertiary care hospital in Islamabad. J Ayub Med Coll Abbottabad. 2020;32(2):215–219.
Ghosh S, Williams DM, Pinto-Plata V, et al. Gender differences in COPD: impact on quality of life and clinical characteristics. Int J Chron Obstruct Pulmon Dis. 2020;15:2095–2105.
Aburahma MH, Mukattash TL, Alzoubi KH, et al. A comparison of dry powder inhaler technique between male and female COPD patients in Jordan. Int J Clin Pract. 2021;75(5):e13992.
Islam MS, Sharifuzzaman M, Rahman MA, et al. Assessment of inhaler technique among COPD patients in Bangladesh: gender perspective. Respir Med Case Rep. 2022;36:101570.
Farkas P, Kovacs G, Bajcsy A. Comparative study of inspiratory flow with different dry powder inhalers in COPD: gender and age considerations. Pulmonology. 2024 Feb;30(2):123–129.
Basheti IA, Armour CL, Reddel HK, Bosnic-Anticevich SZ. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007;119(6):1537–1538.
Malik MA, Awais SM, Iqbal M. Effectiveness of repeated training on inhaler technique in COPD patients attending a pulmonary clinic in Multan. Ann King Edward Med Univ. 2021;27(4):487–492.
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