INTRODUCTION which includes Metered Dose Inhaler (MDI), Dry

INTRODUCTION
Inhalation therapy targets drug delivery to the lungs and allows a distinct therapeutic advantage over systemic therapy with the use of smaller drug dose, a more rapid onset of therapeutic action and decreased side effects. For these reasons, inhalation therapy is recommended and most commonly used mode of drug delivery in bronchial asthma and COPD. One of the important reasons for suboptimal control of asthma and COPD is the insufficient delivery of inhaled drug due to either wrong selection of inhalation device or incorrect inhalation technique. 1.Poor handling and wrong inhalation
technique are associated with decreased medication delivery
and poor disease control 2-4. Various types of
inhaler devices are currently being used in the management
of COPD and BA which includes Metered Dose Inhaler
(MDI), Dry Powder Inhaler (DPI), Metered Dose Inhaler with
Spacer (MDI with Spacer), Breath actuated Metered Dose
Inhaler (baMDI) and Nebulizer. DPIs are devices which require adequate inspiratory flow rate for optimal deposition of drugs in lungs.These devices are easier to use since they overcome the hand lung coordination required in MDI.
The hand lung coordination problem encountered while using MDIs can be overcome by using MDI with spacer. Spacers have various advantages as it assists in pMDI use by reducing the hand lung coordination , by increasing the drug delivery to lungs and simultaneously reducing oropharyngeal deposition and systemic absorption.

Bronchial asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity together with variable expiratory airflow limitation.5 Bronchial asthma is estimated to affect some 300 million people worldwide and accounts for about one per cent of all disability-adjusted life years lost.5 Distinguishing asthma from COPD can be problematic particularly in smokers and older adults. COPD is a common , preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.6 Chronic obstructive pulmonary disease claimed 3.0 million lives in 2016.7

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Now a days, asthma and COPD (Chronic obstructive Pulmonary disease), are mainly treated by inhaled therapy 8. This practice became popular many years after the introduction of atropine and adrenaline, as bronchodilators 9, only when efficient nebulizer ampoules and inhalers 10 finally became available. Three types of dispensers for lung deposition of drugs: A) nebulizers, B) pressurized inhalers and C) the dry powder inhalers; many models of each type are available. In patients with asthma or COPD who show poor inhaler technique with a pMDI, the addition of a large-volume spacer and education from a health professional (rather than simply changing inhalers) might be the best initial strategy for improving inhaler technique 11
Over the decades, inhalation therapy has become the
backbone in the treatment of these disorders, although new inhalers have been designed to improve ease of use, significant rates of incorrect use have been reported among COPD and bronchial asthma patients, even among regular adult users.12
About 90% of COPD and asthma patients are using standard pressurised metered dose inhalers (pMDIs) or dry-powder inhalers (DPIs) with incorrect technique 13
With short-acting ?2 agonists (relievers), poor inhaler technique results in loss of bronchodilator effect 14,15. The patients who use standard pMDIs without a spacer, failure to coordinate inspiration with actuation , results in reduced lung deposition of medication 16.
Education about medications occurs mostly during doctor consultations at the time of prescribing, and yet evidence points to the passivity of the patient and a low level of information exchange during such consultations 17. Incorrect use of pMDIs for inhaled corticosteroids (ICS) has been associated with increased reliever use, increased use of emergency medical services, worsening asthma 18. Inefficient technique with DPIs may also lead to insufficient drug delivery and therefore insufficient lung deposition 19.
Therefore, it is necessary on the part of the physicians, nurses, and other health care providers, to understand the issues related to performance and correct use of these inhaler devices, and also to understand the difficulties faced by patients while using them.

However, only few previous studies have investigated the frequency and impact on asthma control due to poor knowledge regarding correct use of inhalers by patients or health care givers 8.
The present study is being done to find out the usage of inhalation device and assessment of inhalation technique in bronchial asthma and COPD. We are undertaking this study in our institution with the following aims and objectives.

INTRODUCTION
Inhalation therapy targets drug delivery to the lungs and allows a distinct therapeutic advantage over systemic therapy with the use of smaller drug dose, a more rapid onset of therapeutic action and decreased side effects. For these reasons, inhalation therapy is recommended and most commonly used mode of drug delivery in bronchial asthma and COPD. One of the important reasons for suboptimal control of asthma and COPD is the insufficient delivery of inhaled drug due to either wrong selection of inhalation device or incorrect inhalation technique. 1.Poor handling and wrong inhalation
technique are associated with decreased medication delivery
and poor disease control 2-4. Various types of
inhaler devices are currently being used in the management
of COPD and BA which includes Metered Dose Inhaler
(MDI), Dry Powder Inhaler (DPI), Metered Dose Inhaler with
Spacer (MDI with Spacer), Breath actuated Metered Dose
Inhaler (baMDI) and Nebulizer. DPIs are devices which require adequate inspiratory flow rate for optimal deposition of drugs in lungs.These devices are easier to use since they overcome the hand lung coordination required in MDI.
The hand lung coordination problem encountered while using MDIs can be overcome by using MDI with spacer. Spacers have various advantages as it assists in pMDI use by reducing the hand lung coordination , by increasing the drug delivery to lungs and simultaneously reducing oropharyngeal deposition and systemic absorption.

Bronchial asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity together with variable expiratory airflow limitation.5 Bronchial asthma is estimated to affect some 300 million people worldwide and accounts for about one per cent of all disability-adjusted life years lost.5 Distinguishing asthma from COPD can be problematic particularly in smokers and older adults. COPD is a common , preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.6 Chronic obstructive pulmonary disease claimed 3.0 million lives in 2016.7

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Now a days, asthma and COPD (Chronic obstructive Pulmonary disease), are mainly treated by inhaled therapy 8. This practice became popular many years after the introduction of atropine and adrenaline, as bronchodilators 9, only when efficient nebulizer ampoules and inhalers 10 finally became available. Three types of dispensers for lung deposition of drugs: A) nebulizers, B) pressurized inhalers and C) the dry powder inhalers; many models of each type are available. In patients with asthma or COPD who show poor inhaler technique with a pMDI, the addition of a large-volume spacer and education from a health professional (rather than simply changing inhalers) might be the best initial strategy for improving inhaler technique 11
Over the decades, inhalation therapy has become the
backbone in the treatment of these disorders, although new inhalers have been designed to improve ease of use, significant rates of incorrect use have been reported among COPD and bronchial asthma patients, even among regular adult users.12
About 90% of COPD and asthma patients are using standard pressurised metered dose inhalers (pMDIs) or dry-powder inhalers (DPIs) with incorrect technique 13
With short-acting ?2 agonists (relievers), poor inhaler technique results in loss of bronchodilator effect 14,15. The patients who use standard pMDIs without a spacer, failure to coordinate inspiration with actuation , results in reduced lung deposition of medication 16.
Education about medications occurs mostly during doctor consultations at the time of prescribing, and yet evidence points to the passivity of the patient and a low level of information exchange during such consultations 17. Incorrect use of pMDIs for inhaled corticosteroids (ICS) has been associated with increased reliever use, increased use of emergency medical services, worsening asthma 18. Inefficient technique with DPIs may also lead to insufficient drug delivery and therefore insufficient lung deposition 19.
Therefore, it is necessary on the part of the physicians, nurses, and other health care providers, to understand the issues related to performance and correct use of these inhaler devices, and also to understand the difficulties faced by patients while using them.

However, only few previous studies have investigated the frequency and impact on asthma control due to poor knowledge regarding correct use of inhalers by patients or health care givers 8.
The present study is being done to find out the usage of inhalation device and assessment of inhalation technique in bronchial asthma and COPD. We are undertaking this study in our institution with the following aims and objectives.

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