Prevalência e fatores de risco associados à não conformidade técnica no uso de dispositivos inalatórios em pacientes com doenças respiratórias crônicas

Abstract

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are chronic respiratory diseases that affect millions of people worldwide, resulting in high morbidity and mortality. Improper use of inhalation devices (ID) is a critical factor that compromises treatment effectiveness, leading to increased hospitalizations and symptom worsening. This study aimed to detect the prevalence of non-conformity with inhalation technique among patients with asthma and COPD, as well as to identify critical errors and associated risk factors. An observational and cross-sectional study was conducted between May 2022 and July 2024, with 575 patients attending a pulmonology outpatient clinic at a university hospital and a specialized care unit, both in Natal, Brazil. Participants, aged 18 years and older, diagnosed with asthma and/or COPD, completed questionnaires on sociodemographic characteristics and performed the inhalation technique for evaluation. Treatment adherence was assessed using the Morisky-Green-Levine test, while the inhalation technique was analyzed using checklists specific to each ID, considering as critical errors those with the greatest potential to affect medication effectiveness, such as insufficient exhalation, inadequate seal around the mouthpiece, improper inhalation, and failure to perform an inhalation pause. The results showed a high prevalence of non-compliance with the inhalation technique (55.2%), with the most frequent errors being improper inhalation (61.2%) and incorrect inhalation pause (56.6%). Multivariate analysis indicated that factors such as advanced age (OR: 1.016), lower family income (OR: 2.450), worsening of symptoms with exertion (OR: 1.935), and asthma diagnosis (OR: 3.596) were significantly associated with non-conformity in the technique. In conclusion, this study highlights the high prevalence of non-conformity with inhalation technique among patients with asthma and COPD. Identifying and characterizing critical errors and associated risk factors emphasize the importance of developing educational interventions aimed at optimizing the use of IDs and, consequently, improving the control of respiratory diseases.