Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 434 - 439

To Study the Attitudes, Beliefs and Perceptions Regarding the Use of Inhalers among Patients of Obstructive Pulmonary Diseases and in the General Population in Punjab

VITULL K. GUPTA, JAGJEET SINGH BAHIA, ASHWANI MAHESHWARI, SONIA ARORA, VARUN GUPTA, SAHIL NOHRIA

Department of Kishori Ram Hospital & Diabetes Care Centre, Kishori Ram Road, Basant Vihar, BHATINDA, Punjab, India. and Medicine, Adesh Institute of Research and Medical Sciences, Bathinda, Punjab.

Correspondence Address :
Vitull K. Gupta
Health & Human Rights Activist,
ASSISTANT PROFESSOR, AIMSR
Res. 5042, Afim Wali Gali, Bathinda, Punjab 151001.
Ph. (Hosp.) 91-164-2215400. (Res.) 91-164-2253903.
Mobile. 9417020903. e Mail. vitullgupta2000@yahoo.com

Abstract

Introduction: Inhaler devices are an important part of the armamentarium of clinicians who treat ing obstructive pulmonary diseases. The effectiveness of inhaled drugs depends on the patient’s’ ability to use the inhaler device correctly and the adherence to the treatment regimens is likely to be influenced by their opinions and feelings about the use of the inhaler as a mode of therapy. The patients’ beliefs about their illnesses and therapy play a key role in determining their adherence to the treatment.

Aims and Objectives: However, there is paucity of studies investigating attitudes, beliefs and perceptions about the use of inhalers in patents of obstructive pulmonary disease and in the general population in India so we sought to study the attitudes, beliefs and perceptions regarding the use of inhalers by obstructive pulmonary disease patients and by the general population.

Material and Methods: Patients of COPD and asthma and the general population visiting the hospital were screened for recruitment into this study. A questionnaire which could identify the patients’ potential attitudes, beliefs and perceptions about inhalers was designed and the answers were sought during interviews with the first contact OPD patients and the generalpublic visiting the hospital as relatives accompanying the patients, other than the patients of respiratory diseases. All the ‘yes’ answers were analyzed on a percentage scale.

Results: We studied 1276 patients and 1832 people from the general population. Only 15.1% patients and 17.2% subjects from the general population considered inhalers as the preferred mode of therapy . A majority of the patient population and subjects from the general population thought that the use of inhalers was a social stigma and preferred oral medication;, they expressed their inhibitions for inhaler use in public, wanted to keep the inhaler use as a secret, expressed preference for a smaller inhaler device and a single dose inhaler and thought that inhalers are were used in for serious diseases, which once started on, inhalers had to be taken life long.

Conclusion: We conclude that the results of our study highlighted the misplaced beliefs, attitudes and perceptions about inhalers among a majority of the patients and the common population, thus necessitating the urgent need for an individual and a collective national effort in the form of national educative programmes to dispel the misconceptions and inadequate knowledge, beliefs, attitudes and perceptions of the patients and the common people towards inhalers.

Keywords

Bronchial Asthma, COPD, Knowledge, Social Stigma, Inhibition, Oral medication, Perceptions, Beliefs, Attitudes.

How to cite this article :

VITULL K. GUPTA, JAGJEET SINGH BAHIA, ASHWANI MAHESHWARI, SONIA ARORA, VARUN GUPTA, SAHIL NOHRIA. TO STUDY THE ATTITUDES, BELIEFS AND PERCEPTIONS REGARDING THE USE OF INHALERS AMONG PATIENTS OF OBSTRUCTIVE PULMONARY DISEASES AND IN THE GENERAL POPULATION IN PUNJAB. Journal of Clinical and Diagnostic Research [serial online] 2011 June [cited: 2019 Oct 15 ]; 5:434-439. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=June&volume=5&issue=3&page=434-439&id=1388

In recent years, the prevalence of obstructive pulmonary diseases including asthma and chronic obstructive pulmonary disease (COPD) has shown a steady increase, with a corresponding increase in their social and economic impact. Bronchial asthma and COPD are two chronic obstructive airway diseases that exact an enormous toll on the patients, healthcare providers and the society. India has an estimated 15 to 20 million asthmatics. Rough estimates indicate a prevalence of between 10% and 15% in children in the age range of five to eleven years. The median prevalence rates of COPD were assessed as 5 % for males and 2.7 % for female subjects of over 30 years of age . In India, COPDwas accounted for 2.8% of the total deaths in 1990 and it was expected to rise to 6.5% deaths by 2020 . Much of the morbidity from asthma is believed to be due to factors such as the denial of having a chronic condition , poor knowledge about the disease process and medication use , poor understanding about the use of inhalers and poor self-management. Patient decisions to follow the recommended treatment are likely to be influenced by their beliefs about medicines, as well as their beliefs about the illness that the medication is intended to treat or prevent.

Inhaler devices are an important part of the armamentarium of clinicians who treat both these obstructive pulmonary diseases.

The effectiveness of inhaled drugs depends on the patients’ ability to use the inhaler device correctly and adherence to the treatment regimens is likely to be influenced by their opinions and feelings about the use of inhalers as a mode of therapy. The successful management of COPD and asthma requires attention not only to the observable behaviour of the patients, but also to the underlying attitudes and beliefs which drive that behaviour. It is a well accepted fact that the patients’ views should be taken into account during the medical decision-making and the choice of therapy.

The patients’ beliefs about their illnesses and therapy play a key role in determining their adherence to the treatment. Unless the patients possess basic knowledge about the ailment and its management, there is no chance to make the best use of the available facilities, thus resulting in the poor control of the disease. Beliefs and attitudes influence the behaviour and some theoretical models can explain up to 30% of the health behaviour

Aims and Objectives
However, there is paucity of studies which have investigated the attitudes, beliefs and perceptions about the use of inhalers in patents of obstructive pulmonary disease and in the general population in India and so we sought to study the attitudes, beliefs and perceptions regarding the use of inhalers by the obstructive pulmonary disease patients and the general population.

Material and Methods

Patients of COPD and asthma and the general population who visited the hospital were screened for recruitment into this study. To be eligible for the study, the subjects had to: (1) be between the ages of 15 and 60 years, (2) know about inhalers as a treatment modality (3) be from the general population who visited the hospital with patients who had some other disease than respiratory disease (4) be a patient of COPD or asthma. Those subjects who were above the age of 60 years or below 15 years, those who had not heard about inhalers as a treatment modality, patients who were other than COPD or asthma patients and people who accompanied the respiratory disease patients were excluded from the study. A questionnaire which could identify the potential attitudes, beliefs and perceptions about inhalers was designed for this study by the investigators. The study questions were not validated. Answers were sought during interviews with the first contact OPD patients of COPD and bronchial asthma and the general public who visited the hospital as relatives who accompanied the patients who had diseases other than respiratory diseases. The subjects’ ability to answer the question was assessed by using the “yes” and “no” categories and the ‘do not know’ option was not considered. The questions included: 1. Do you consider inhalers as the preferred mode of therapy? 2. Do you consider inhaler use as a social stigma? 3. Do you prefer oral medication over inhalers? 4. Do you feel inhibition for inhaler use in public? 5. Will you prefer to keep the inhaler use a secret? 6. Will you prefer a smaller device? 7. Will you prefer a single dose inhaler? 8. Do you think that the inhaler is used for serious diseases? 9. Do you think that once started on, inhalers have to be taken life long? All the ‘yes’ answers were analyzed on a percentage scale. Those subjects who were not able to read or write any local language were categorized as illiterate and those who were able to read or write any local language were categorized as literate.

Those subjects who belonged to an area which was governed by municipal committees or corporations were categorized as urban and those who belonged to areas which were governed by panachyats were categorized as rural subjects.

Results

We studied 1276 patients and 1832 people from the generalpopulation. (Table/Fig 1) shows the demographic distribution among the study population. The patient population of 1276 included 61.3% males and 38.7% females, 40.1% were illiterate and 59.9% were literate and 46.3% belonged to the urban areas and 53.7% to the rural areas. Similarly, the general population of 1832 subjects included 59.2% males and 40.8% females and 49.8% illiterate, 50.2 % literate, 48.6% urban and 51.4% rural subjects. The results of the response to the questions by the patients are shown in (Table/Fig 2) and the response by the generalpopulation is shown in (Table/Fig 3). Only 15.1% patients and 17.2% subjects from the general population considered inhalers as a preferred mode of therapy and among both the groups, the responses of males and, the literate and the urban subjects were as better than that of the females illiterates, and the rural subjects. The graphical comparison for the response to the question no 1 by the patients and the general population including the males,females, illiterates, literates and the, urban and rural subjects is expressed in (Table/Fig 4).

A majority of the patient population (86.8%) and subjects from the general population (84.2%) thought that the use of inhalers was a social stigma and this view was more prevalent among females, illiterates and rural subjects among both the groups. (Table/Fig 5) demonstrates the comparative response of the males, females, illiterates, literates and the urban and rural subjects among both the groups.

Oral medication was preferred by 90.7% patients including 87.7% males, 95.3% females, 95.1% illiterates, 87.6% literates and 86.6% urban and 94.2% rural patients. Similarly, a preference was expressed by 92.4% subjects among the general populationand by females (94.8%), illiterates (96.3%) and rural subjects for oral medication than the males (90.7%), literates (88.5%) and the urban (87.3%) subjects. (Table/Fig 6) expresses the comparative results among the males, females, illiterates, literates and theurban and rural subjects of both the groups.

89.5% patients and 87.8% subjects among the general population expressed an inhibition for inhaler use in public and this feeling of inhibition was more among the females, illiterates and the rural subjects among both the groups. The comparison of the response of inhibition among the males, females, illiterates, literates and the urban and rural subjects of both the groups is shown in (Table/Fig 7). 91.6% patients and 93.3% subjects among the general population wanted to keep the inhaler use a secret and this secretive tendency was more among females, illiterates and rural subjects in both the groups. (Table/Fig 8) expresses as to how the subjects from both the groups responded to question no. (5).

The results of our study showed that 95.5% patients including 95.4% males, 95.7% females, 96.6% illiterates, 94.8% literates, and 93.7% urban and 97.1% rural subjects preferred a smaller inhaler device and almost a similar response was expressed by subjects from the general population. (Table/Fig 9) shows the graphic analysis of the comparative responses of the males, females, illiterates, literates and the urban and rural subjects among both the groups to the question of preference for a smaller device.

The preference for a single dose inhaler was expressed by 96.7% of the patients and 94.2% subjects from the general population. The results showed that the preference for a single dose inhaler was expressed by all the groups and the comparative analysis about this is expressed in (Table/Fig 10).

The results of our study showed that 84.9% patients and 82.6% subjects from the general population thought that inhalers were used for serious diseases and this thought was more among females, illiterates and the rural population in both the patient and the general population groups. [Table/Fig 11] shows the comparative thoughts among all the groups which were studied.

79.6% patients and 75.9% subjects from the general population nursed the belief that once started on, inhalers had to be taken life long and this belief was more among females, illiterates and rural patients and subjects, as compared to the males, literates and the urban subjects. [Table/Fig 12] shows the graphic representation of the comparative beliefs among both the groups (6).

Discussion

Patients’ beliefs and practices play a role in understanding, defining and responding to illness and so, our study was aimed at exploring the existing attitudes, beliefs, and perceptions of the patients and the general population with regards to inhalers as a treatment modality. People have different levels of knowledge about the use of inhalers in obstructive pulmonary diseases disease and diverse underlying disease-related beliefs. The patients’ use of inhaler devices and their adherence to the treatment regimens is likely to be influenced by their attitudes, beliefs, and perceptions about inhalers. Moreover, the attitudes, beliefs, and perceptions of the general population regarding the use of inhalers will influence the acceptability of inhalers in society. Incorrect underlying beliefs about inhaler use may constitute a major obstacle to the adherence to disease management and other self-management behaviour, and such beliefs thereby, may contribute to poor treatment outcomes.

There is a global problem with asthma management, either under treatment due to ignorance or due to the distorted information/ knowledge of the patients about their disease and a similar situation is also expected with respect to COPD management. The present study reveals that an average patient has misconceptions, which need to be rectified.

The analysis of the results showed that only 15.1% patients and 17.2% subjects of the general population considered inhalersas the preferred mode of therapy and the preference for inhaler therapy was expressed more by males (17.1%), literates (20.6%) and urban (20.4%) patients than the females (11.7%), illiterates (6.6%) and the rural (10.3%) patients. Almost a similar result pattern was observed in the general population regarding inhalers as the preferred mode of therapy. In a study on 135 patients, (7) (5.2%) patients preferred to use inhaled drugs. In the same study, out of the total 135 patients, 26(19.3%) were not prescribed any inhaled therapy by their doctors. Of the 109 patients, who were prescribed inhaled therapy, 30(27.5%) patients discontinued the use of inhalers or feared using inhalers because of social factors (43.3%) and reasons such as the difficulty in using it (63.3%), the difficulty in carrying it (33.3%) and its habit forming (53.3%) property. In our study, a large number of patients (86.8%) and people from the general population (84.2%) considered inhaler use as a social stigma. More number of females, illiterates and rural subjects, both from the patient and the general populations considered inhaler use as a social stigma than the males, literates and the urban subjects. 90.7% patients and 92.4% people preferred oral medication over the inhalers. Oral medication was preferred by females, illiterates and the rural subjects, both from the patient and the general population. In a national (UK) survey , a significant number of patients (41%) expressed concern about using their inhalers in public, whereas in our study, many more, that is 89.5% patients and 87.8% people felt an inhibition for the use of inhalers in public. Moreover, in our study, this inhibition was more prevalent in females, illiterates and rural patients, as well as in subjects from the general population. In our study, 91.6% patients and 93.3% people preferred to keep the inhaler use a secret, whereas in the national (UK) survey, 22% preferred to keep their inhalers hidden and 19% preferred that others should not know about their inhaler use.

The results of the National UK survey showed that 75% felt that it was important for the devices to be small and 76% felt that it should be easy to carry inhalers around, but in our study, more number of subjects, ie. 95.5% patients and 97.5% of the general population preferred a smaller device. In comparison to 77% expressing a preference for minimizing the number of daily doses and 59% preferring a single inhaler in the UK study, in our study, 96.7 % patients and 94.2 % subjects from the general population expressed a desire for a single dose inhaler. The misconception that inhalers were used for serious disorders was quite common among the patients (84.9%) and the common people (82.6%). 79.6% patients and 75.9% people thought that once inhalers were started on, they had to be taken life long.

The analysis of the data showed that the attitudes, beliefs, and perceptions of males, literates and urban patients and subjects from the general population regarding the use of inhalers were better with respect to the prevalence of the misconceptions, wrong attitudes, beliefs and the perceptions among the females, illiterates and the rural patients and subjects from the general population. Observations on the lack of awareness among the patients about the benefits of inhaled therapy have also been reported by Bedi in his study which was carried out among 160 patients of rural Punjab. In his study, only 18% patients agreed to try inhaler therapy, even after motivation. Our study has some limitations. All subjects were chosen from the outpatient clinic of the hospital and all the interviews were conducted by the first author of the study. This might have resulted in a bias in the sample which was studied and may have led the patients orthe subjects to certain answers. For future research, to reduce the sample bias, more community-based investigations should be undertaken to represent the full spectrum of the people. In addition, more standardized questionnaires should be used to assess the patients’ and the general populations’ attitudes, beliefs and perceptions. Improvement in the quality of care in asthma and COPD requires a comprehensive knowledge of the patients and the management of their disease. It has been suggested that the patients are relatively unaware that most of their asthmarelated problems are due to inadequate control, and that a more appropriate behaviour towards the asthma control therapy could improve this situation .

Therefore, it has been suggested that better patient education is necessary in order to improve the management of asthma. Studies have reported that a better knowledge of the disease in the patients improved the adherence to treatment and changed their perception of the disease (8)(9)(10)(11)(12)(13)(14)(15).

Conclusion

We conclude that the results of our study highlighted the misplaced beliefs, attitudes and perceptions about inhalers among a majority of the first contact patients and the common population, which are more prevalent in females, illiterates, and rural subjects as compared to the males, literates and the urban subjects. We feel that such misplaced beliefs, attitudes and perceptions about inhalers among a majority of subjects will definitely inhibit the proper utilization of inhaler therapy. More importantly, the results have necessitated the urgent need for an individual and a collective national effort in the form of national educative programmes to dispel the misconception and inadequate knowledge, beliefs, attitudes and the perceptions of the patients and the common people towards inhalers. Sincere and sustained efforts are required to disseminate the knowledge about all the aspects of COPD and asthma and their management amongst the patients and to dispel their myths and misconceptions which are associated with these diseases and their therapy. This will help the patients to participate in self-management plans and for a better control of their disease.

Key Message

Patients’ beliefs and practices play a role in understanding, defining and responding to illnesses. The attitudes, beliefs, and perceptions of the general population regarding the use of inhalers, is going to influence the acceptability of inhalers in the society. The present study reveals that on an average, the patients and the general population has misconceptions regarding the use of inhalers as a treatment modality, which needed to be rectified.

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