Assessment of inhalation technique in primary care asthmatic patients using metered-dose inhalers with or without a spacer. 
Asthma is a chronic disease with increasing morbidity and mortality.  Although the development of metered-dose inhalers (MDIs) was a landmark in asthma management, their use is burdened by inappropriate training.  Inadequate inhalation technique is reported in 24% to 89% of patients.  We assessed how a sample of adult asthmatic patients seen in primary healthcare clinics (PHCs) in Riyadh used their metered-dose inhalers (MDI).  We conducted a cross-sectional survey of asthmatic adults â yen 18 years of age who attended PHCs and used an MDI with or without a spacer device.  Patient inhalation technique was observed independently by the primary researcher and a respiratory therapist using a checklist based on US (National Heart, Lung and Blood Institute) asthma management guidelines.  The mean age of the 191 patients in the survey was 40.64 years (range, 18 to 80 years).  Fifty-nine percent were females and 41% were males.  Most (77%) were illiterate and most (86%) had received previous education on MDI inhalation technique.  Ninety-three percent were using an MDI without a spacer, but none could use their MDI without committing at least one error in both groups.  In patients using an MDI without a spacer, the most common error was not tilting the head backward slightly and breathing out to residual volume (85%), followed by not breathing in slowly (84%).  In patients using an MDI with a spacer, the most common errors were not tilting the head back slightly and breathing out slowly to residual volume (77%), and not holding the breath for 10 seconds (77%).  Despite that MDIs are a mainstay in the management of our asthmatic patients, inhalation technique is very poor among our patients.