Inhaler technique, training source, and waste-disposal behavior among inhaler users: A retrospective analysis

Aim: Despite the widespread availability of inhaler therapy, more than half of patients make critical errors during inhaler use, leading to suboptimal drug delivery and poor disease control. The environmental impact of inhaler use has also gained global attention, highlighting the need for sustainable disposal and waste-management practices. However, studies simultaneously evaluating inhaler technique, formal education level, training source, and inhaler waste-management behaviors remain limited.

Materials and Methods: This retrospective descriptive study included 90 adult patients treated with inhaler therapy at Muğla Training and Research Hospital between July 2024 and June 2025. Data were obtained from standardized “Inhaler Treatment User Control Forms,” including demographic characteristics, diagnosis, disease duration, smoking status, inhaler type, training status, and inhaler performance scores across five technique steps. The disposal behavior of used inhalers was also recorded. Statistical analyses were performed using the Mann–Whitney U, Kruskal–Wallis H, and Spearman correlation tests, with a significance level of p < 0.05. Multivariable linear regression was performed to assess independent associations with total inhaler technique score.

Results: 48.9% of inhaler users reported that they had not received training. Physician-led training was associated with significantly higher total inhaler technique scores compared with untrained patients or those trained by pharmacist/pharmacy technicians (p < 0.001). In multivariable linear regression, physician-led training remained independently associated with higher total inhaler technique scores after adjustment for age, education level, disease duration, and inhaler type (B = 4.323, 95% CI: 3.120 – 5.526, p < 0.001). The total score showed a moderate positive correlation with inhaler duration (r = 0.446, p < 0.001). All participants reported disposing of used inhalers in household trash, indicating low awareness of appropriate medical or recycling waste practices.

Conclusion: Physician-led inhaler education was independently associated with higher inhaler technique scores, whereas awareness of appropriate inhaler disposal appeared insufficient. Future prospective studies should evaluate whether integrating environmental disposal education into inhaler training can improve disposal behavior and support more sustainable respiratory care.