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. 2023 Aug 16;17:2025–2038. doi: 10.2147/PPA.S417375

Table 5.

Evaluation of the Total Number and Specific Number of Steps of the Inhalation Systems Studied in This Research

Inhalation Systems Steps Technique Evaluation n (%)
Metered-dose inhaler with spacer 1) Uncover the cartridge Correct 39 (100.0%)
2) Shake Correct 37 (94.87%)
Incorrect 2 (5.13%)
3) Hold it vertically (L-shaped) Correct 39 (100.0%)
4) Make a maximum expiration Correct 22 (56.41%)
Incorrect 17 (43.59%)
5) Place the cartridge nozzle in the mouth and close completely Correct 39 (100.0%)
6) Inhale slowly through the mouth (tongue on the roof of the mouth) Correct 39 (100.0%)
7) In inspiration, press the cartridge once and inspire up to the total lung capacity Correct 39 (100.0%)
8) Apnea (Holding your breath for 10 seconds) Correct 22 (56.41%)
Incorrect 17 (43.59%)
9) Wait half a minute between each shot Correct 32 (82.05%)
Incorrect 7 (17.95%)
Total correct steps 308 (87.8%)
Total incorrect steps 43 (12.2%)
Metered-dose inhaler without spacer 1) Uncover the cartridge Correct 34 (100.0%)
2) Shake Correct 34 (100.0%)
3) Hold it vertically (L-shaped) Correct 34 (100.0%)
4) Make a maximum expiration Correct 23 (67.64%)
Incorrect 11 (32.36%)
5) Place the cartridge nozzle in the mouth and close completely Correct 34 (100.0%)
6) Inhale slowly through the mouth (tongue on the roof of the mouth) Correct 28 (82.35%)
Incorrect 6 (17.65%)
7) In inspiration, press the cartridge once and inspire up to the total lung capacity Correct 28 (82.35%)
Incorrect 6 (17.65%)
8) Apnea (Holding your breath for 10 seconds) Correct 21 (61.76%)
Incorrect 13 (38.24%)
9) Wait half a minute between each shot Correct 28 (82.35%)
Incorrect 6 (17.65%)
Total correct steps 264 (86.3%)
Total incorrect steps 42 (13.7%)
Multi-dose dry powder inhaler Turbuhaler type 1) Uncover the device Correct 18 (100.0%)
2) Turn the lower wheel to one side as far as it will go and then to the other side until it clicks Correct 18 (100.0%)
3) Expel air through the mouth keeping the inhaler away from the mouth Correct 18 (100.0%)
4) Place the mouthpiece between the teeth and close the lips Correct 18 (100.0%)
5) Inspire energetically and deeply Correct 14 (77.78%)
Incorrect 4 (22.22%)
6) Apnea – (Hold your breath for 5 seconds) Correct 14 (77.78%)
Incorrect 4 (22.22%)
7) Close the nozzle compartment Correct 18 (100.0%)
8) Cover the device Correct 18 (100.0%)
Total correct steps 136 (94.4%)
Total incorrect steps 8 (5.6%)
Multi-dose dry powder inhaler Accuhaler type 1) Uncover the device Correct 17 (100.0%)
2) Move the reed until you hear the “click” Correct 17 (100.0%)
3) Expel air through the mouth keeping the inhaler away from the mouth Correct 6 (35.3%)
Incorrect 11 (64.7%)
4) Place the mouthpiece between the teeth and close the lips Correct 17 (100.0%)
5) Inspire energetically and deeply Correct 17 (100.0%)
6) Apnea – (Hold your breath for 5 seconds) Correct 6 (35.3%)
Incorrect 11 (64.7%)
7) Close the nozzle compartment Correct 17 (100.0%)
8) Cover the device Correct 17 (100.0%)
Total correct steps 114 (83.8%)
Total incorrect steps 22 (16.2%)
Single-dose dry powder inhaler 1) Uncap the device (Slide the inhaler cap) Correct 30 (100.0%)
2) Insert the capsule, close the compartment, and puncture the capsule Correct 30 (100.0%)
3) Expel air through the mouth keeping the inhaler away from the mouth Correct 17 (56.67%)
Incorrect 13 (43.33%)
4) Place the mouthpiece between the teeth and close the lips Correct 30 (100.0%)
5) Inspire energetically and deeply Correct 30 (100.0%)
6) Apnea – (Hold your breath for 10 seconds) Correct 17 (56.67%)
Incorrect 13 (43.33%)
7) Discard the capsule completely empty Correct 30 (100.0%)
8) Cover the device Correct 30 (100.0%)
Total correct steps 214 (89.2%)
Total incorrect steps 26 (10.8%)
Soft mist inhaler 1) Hold the inhaler upright and covered Correct 34 (100.0%)
2) Rotate the base 180 degrees towards the arrows until you hear a “click” Correct 34 (100.0%)
3) Open the lid Correct 34 (100.0%)
4) Gently exhale Correct 27 (79.42%)
Incorrect 7 (20.58%)
5) Closing lips around the mouthpiece without covering the air valves Correct 34 (100.0%)
6) Press the button while inhaling deeply Correct 34 (100.0%)
7) Apnea – (Hold your breath for 5 seconds or until possible) Correct 30 (88.24)
Incorrect 4 (11.76%)
8) Close the lid Correct 34 (100.0%)
Total correct steps 261 (95.6%)
Total incorrect steps 11 (4.4%)