Comparison of the three liquid metered dose inhalers technique in patients with COPD and bronchial asthma

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In respiratory medicine, the correct inhaler technique determines the clinical efficacy of inhaled medications.


To evaluate the standard metered dose inhaler (MDI), Rapihaler MDI and Respimat inhaler technique in patients with COPD and asthma and to identify factors affecting the technique of inhalation.

Material and methods

Two hundred and eight patients, including 100 patients with COPD and 108 asthmatic patients, were enrolled in observational non-interventional study. Three inhalers were tested within one day in random order. Inhaler technique was evaluated prior to and after reading instruction for medical use and after education by investigator.


The frequency of proper MDI, Rapihaler and Respimat technique in patients with COPD was 30.0%, 30.0% and 13.0%, respectively, prior to reading instruction for medical use, 34.0%, 45.0% and 43.0% after reading instruction and 72.0%, 78.0% and 93.0% after education by investigator. In asthmatic patients, these values were 51.9%, 52.8% and 10.2%; 57.4%, 68.5% and 61.1%; 88.9%, 90.7% and 97.2%, respectively. While using all devices patients frequently did not take a deep calm breath and did not hold the breath. Cognitive impairment, age over 65 years, decreased vision and hand joints disease were associated with improper inhaler technique.


Only personal training of patients with COPD or bronchial asthma by a health care provider ensures proper inhaler technique.

Key words

Inhalers, COPD, bronchial asthma, inhalation technique