Background: Geriatric patients often need to use spacers with their MDI inhalers because of poor respiratory conditions. However, stigma or lack of knowledge may create obstacles to optimal medication outcomes and proper inhaler technique (IT).

Objectives: To assess the relationship between stigma, knowledge of inhalers, and IT, followed by a counseling session to reduce the degree of stigma, improve knowledge, and proper IT. Further, evaluate the feasibility to conduct such a study with a larger sample size. 

Methods: This pilot study (n=38) recruited geriatric (age>65), asthma/COPD patients, who use spacers with MDI, from a specialized respiratory hospital in Bangladesh. The study duration was three months. Degree of stigma, knowledge of inhaler, inhaler technique, and peak expiratory flow (PEF) rate were assessed at baseline, followed by a counseling session. Reassessment was done after 3-6 weeks. Pearson?s correlation was used to test relationships. Paired sample t-test was applied to test the significant differences in the scores between pre and post-counseling. 

Results: In this study (n=38), PEF rate (%) was 34.15±(15.07). Stigma was inversely correlated with inhaler technique(r=-0.484, p<0.01) and knowledge (r=-0.509, p<0.01). The correlation between knowledge and inhaler technique was not significant. During reassessment, stigma significantly reduced t(df) = 3.792(37), p<0.01), and IT improved t(df)=-3.804(37), p<0.01). No significant difference was found in the PEF rate or knowledge.

Conclusion: Stigma was associated with poor IT. Counseling on stigma and IT is an effective strategy. Further study with a larger sample of different populations will be useful for better understanding.