Assessment of Asthma Control and Inhaler Technique in Outpatient Settings

Background: Despite the availability of effective inhaled pharmacotherapy, a substantial proportion of asthma patients fail to achieve optimal disease control. Poor inhaler technique represents a critical yet frequently overlooked barrier to effective drug delivery and clinical outcomes. This study aimed to assess the level of asthma control and evaluate inhaler technique proficiency among adult asthma patients attending outpatient clinics, and to determine the association between inhaler technique errors and asthma control status. Methods: A cross-sectional observational study was conducted across four hospital-based outpatient pulmonology and allergy clinics. A total of 520 adult patients with physician-diagnosed asthma using inhaler devices for ≥3 months were enrolled. Asthma control was assessed using the Asthma Control Test (ACT), and inhaler technique was evaluated through direct observation using device-specific validated checklists. Spirometric assessment, medication adherence (Medication Adherence Report Scale for Asthma, MARS-A), and demographic and clinical variables were systematically recorded. Results: The mean ACT score was 16.8 ± 4.6, with only 34.2% of patients achieving well-controlled asthma (ACT ≥20). Critical inhaler technique errors were identified in 56.7% of participants. The most common critical errors were failure to exhale before inhalation (42.3%), incorrect inspiratory flow rate (38.1%), and failure to hold breath after inhalation (34.6%). Patients with critical errors had significantly lower ACT scores (14.8 ± 4.2 vs. 19.4 ± 3.8, p < 0.001) and lower FEV₁% predicted (68.4 ± 16.2% vs. 78.6 ± 14.8%, p < 0.001). Multivariable analysis identified critical inhaler errors (aOR 3.18, 95% CI 2.14–4.72, p < 0.001), poor medication adherence (aOR 2.64, 95% CI 1.78–3.92, p < 0.001), and absence of prior inhaler education (aOR 2.42, 95% CI 1.62–3.61, p < 0.001) as independent predictors of uncontrolled asthma. Conclusion: The majority of asthma patients in outpatient settings demonstrate suboptimal disease control, with critical inhaler technique errors affecting more than half of users. Inhaler technique proficiency is independently and strongly associated with asthma control status. Systematic assessment and regular reinforcement of inhaler technique should be integrated into routine asthma management.