Abstract
<title>Abstract</title> <p>Objective To investigate the incidence of unqualified key step operation of inhalation devices in patients with Chronic Obstructive Pulmonary Disease (COPD) and analyze its influencing factors. Methods A total of 316 COPD patients who were hospitalized in the Department of Respiratory Medicine of our hospital from January 2025 to November 2025 and used inhalers were selected. The unqualified key step operation of inhalation devices was evaluated, and Logistic regression analysis was used to analyze the influencing factors of unqualified key step operation. Results Among the 316 COPD patients included, 250 patients (79.1%) had at least one key step error. Among them, 82 cases (82.0%) had key step errors with pressurized metered-dose inhalers (pMDI), and 168 cases (77.8%) had key step errors with dry powder inhalers (DPI). The unqualified rates of key step operations from high to low were: insufficient exhalation before inhalation, no breath-holding/insufficient breath-holding time, hand-mouth incoordination/no rapid forceful inhalation/no slow deep inhalation, not placing the mouthpiece between the upper and lower teeth/not sealing the mouthpiece tightly, and not shaking/not correctly opening the device. Logistic regression analysis results showed that age and short duration of inhalation device use were influencing factors for unqualified key step operation of inhalation devices in COPD patients (P < 0.05). Conclusion The unqualified rate of key step operation of inhalation devices in COPD patients is high. Patients aged > 70 years and those with a short duration of inhalation device use should be the focus of training. Healthcare professionals should select appropriate inhalation devices for patients based on comprehensive factors such as their condition and respiratory capacity, carry out targeted education on the operational difficulties of key steps for different devices, and optimize follow-up pathways to help patients improve their inhalation technique.</p>