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Practical Strategies to Improve Asthma Control in Resource Limited Settings

Saeed H, Osama H, Ammari WG, Mohamed BM, Abdelrahim M.

RDD Asia 2024. Volume 1, 2024: 30-37.

Abstract:

The Global Initiative for Asthma (GINA) global recommendations for managing asthma place a strong emphasis on patients following their recommended inhaler dosage schedule and using their inhalers correctly. Asthma control in resource-limited settings is challenging to accomplish since the required medication is expensive, in addition to the costs associated with patient training to ensure inhalers are used properly. Effective use of pressurized metered dose inhalers (pMDIs) can lead to improved lung function and asthma outcomes. Continuous verbal counseling has been shown to reduce inhalation technique errors, however some steps are complex to teach and be mastered by the patient. Consequently, add-on training devices have been developed that produce sounds which guide the patient to inhale at the correct inhalation flow (audio-feedback) and can be detected by smartphone applications (visual feedback). Patients can practice and master using a slow inhalation flow with these add-on training devices during regular inhaler use.

Additionally, GINA recommends using spacers with pMDIs to reduce oropharyngeal drug deposition and address the widespread issue of patients’ inability to coordinate inhalation with actuation. Most of the available spacers are expensive, which limits their use in resource-limited settings. This article introduces a novel carton-based spacer MDI Plus where the carton of the pMDI is used as a spacer. MDI Plus is designed to improve aerosol delivery from pMDIs and reduce costs. The carton-based spacer has been shown to improve patients’ ability to use their MDIs correctly with minimal training compared to pMDI alone. Fewer training sessions for effective use are required and MDI Plus demonstrates reasonable durability over the pMDI life. These findings suggest that carton-based spacers offer a practical, affordable alternative to traditional spacers, particularly in resource-limited settings.