Do correct steps using pMDI technique with spacer predict no exacerbations of Asthma or COPD

Intro: Poor pMDI technique may result in inadequate delivery of medicine in the airways. Spacer devices are often recommended for patients with poor inhaler technique. Aim: To study whether poor inhaler technique in group of patients with high use of a spacer device predicted exacerbations. Method: 208 patients, 79% asthma, 21% COPD, from a hospital clinic and the community were interviewed, and observed on proper pMDI technique with spacer (63.5%) or without, checking for 12 steps, 4 of which were considered critical. Regression analysis was performed to determine if the number of correct steps indentified no exacerbation in the previous year. Results: 101(48.6%) had an exacerbation defined as a health care utilization for worsening symptoms, 73(35.1%)needed oral steroids in the previous year. Correct critical steps (0-4) OR 1.13(95%CI0.88-1.44, p=0.34), and total number of correct steps (0-12) OR 1.02(0.88-1.19,p=0.79) failed to identify patients with no exacerbation. Similarly for no steroid courses in previous year OR 1.17(0.92-1.49, p=0.21), and OR 1.04(0.88-1.22,p=0.67). Other covariates for no exacerbation: spacer use OR 1.47(0.78-2.77,p=0.24), Male Gender OR2.96(1.54-5.66,p=0.001), Age decade 1.33(1.06-1.67,p=0.01), LABA aerolizer 0.41(0.21-0.77, p=0.01), inhaled steroid pMDI 0.85(0.29-2.47,p=0.76), inhaled ipratropium pMDI 0.72(0.22-2.35,p=0.59), Influenza vaccine 1.58(0.83-3.02, p=0.16), Pneumo vaccine 0.64(0.28-1.46.p=0.29), Asthma 1.81(0.54-6.05,p=0.33). Conclusion: In this small population Spacer use and the number of correct pMDIsteps failed to identify patients with no exacerbation in the previous year.