An Assessment of Quality of Life in Libyan Patients with Bronchial asthma: a Clinical Benefit in using most Desirable Inhaler Techniques

  • Fathi Mohamed Sherif Department of Pharmacology & Clinical Pharmacy, UoT, Tripoli, Libya
  • Walid Y. Tarsin University of Tripoli
  • Nabila A. Hshad University of Tripoli
  • Ishraq Elshamli Tripoli Medical Centre
  • Henry Chrystyn Plymouth University
Keywords: Asthma, COPD, MDI, Lung drug delivery, 2 Tone trainer, Libya


Inhaled drug therapy remains the treatment option of choice for majority of patients with asthma. Asthma is a major chronic inflammatory disease of the respiratory tract. This study is designed to evaluate if the use of 2Tone helps patients maintain the correct inhalation technique after training and can improve their quality of life using AQLQ (Asthma quality of life questionnaire) and JMI (Jones morbidity index) questionnaires. AQLQ is a disease-specific health related quality of life tool which has good measurement properties and valid as an evaluative and a discriminative instrument. JMI is used as a simple and practical tool for asthma evaluation morbidity. 125 Libyan asthmatic patients from respiratory department outpatient of medical center (Tripoli) were included. Patients were divided into two groups; intervention and control. The intervention group was divided into those who were verbally trained about the MDI inhalation flow rate technique named verbal group (VT) and those called the 2Tone group (2T). Patients in the 2T group received the same verbal training as the VT group and were given 2Tone Trainer. The second visit for all patients was held six weeks later and each patient was assessed in the same manner as on the first visit. The patient was asked to fill in a self-administered AQLQ and answer questions from JMI. All patients in control group at both visits were inhaling at flow rate < 90 L/min with mean IFR of 66 L/min. Patients mean IFR in VT and 2T groups were less than 90 L/min at visit 2. Comparison of patient’s total AQLQ scores between visits shows no patients in group control group recorded statistical difference. In contrast, 17 patients (48.6%) in VT group and 30 patients (83.3%) in the 2T group recorded significant difference in AQLQ score between visits. Comparisons in morbidity between groups at visits shown that about half of patients in 2T group and 20% of patients in VT group were reduced in the severity category after counselling whereas in control group. There was almost no statistical different between visits. No difference between the patient’s perceptions of symptom control at visit 1 between the groups was observed but a significant difference at visit 2 was noted. Comparison between visits within each group showed that in 2T group patients’ perception of their asthma symptoms improved but did not change in the other two groups. A correlation was very strong between juniper questionnaire and JMI as studied by counselling group with significant association. This study shows that a high correlation between juniper questionnaire and JMI by counselling. This may be a reflection to use JMI as a quick tool to evaluate asthmatic patients to save time and increase patient compliance.


Download data is not yet available.

Author Biographies

Fathi Mohamed Sherif, Department of Pharmacology & Clinical Pharmacy, UoT, Tripoli, Libya

Fathi Sherif is a professor of pharmacology and is currently a vice-dean of faculty of pharmacy, University of Tripoli, Libya. He received his PhD in medicinal pharmacology from faculty of Medicine, University of Uppsala, Sweden (1992) and postdoctoral training in neuroscience in Uppsala University. He won WHO award for the youngest medical researcher in 1995 from world health organization. He is a lecturer of pharmacology at department of pharmacology and clinical pharmacy since 1993 and held a position of head of the department and head of postgraduate office at the university. Head of research unit at National Medical Research Center of ethno-pharmacology (traditionally used of medicinal plants and their potential actions on the CNS using animal behavioral models). A long-term involve in neuropsycho-pharmacology (GABA & MAO systems) in patients as well as long interest in animal behavioral pharmacology. He published several articles about the role of inhibitory transmitters in neuropsychiatric disorders. He supervising several postgraduate students in the area of clinical and basic pharmacology leading to M.Ph. He is a referee of several international journals and an editor in chief of Libyan J Med Res (ISSN 2312-5365) for the last five years and Pharmacy and Pharmacology International Journal (ISS 2373-6367).

Walid Y. Tarsin, University of Tripoli

Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, University of Tripoli, Tripoli, Libya

Nabila A. Hshad, University of Tripoli

Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, University of Tripoli, Tripoli, Libya

Ishraq Elshamli, Tripoli Medical Centre

Department of Respiratory, Tripoli Medical Centre, Tripoli, Libya.

Henry Chrystyn, Plymouth University

Inhalation Consultancy Ltd, Yeadon, Leeds and Faculty of Human and Health Sciences, Plymouth University, Plymouth, United Kingdom


To T, Stanojevic S, Moores G, Gershon AS, Bateman ED, Cruz AA, Boulet LP (2012) Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health 12: 204. doi: 10.1186/1471-2458-12-204.

Tarraf H, Aydin O, Mungan D, Albader M, Mahboub B, Doble A, Lahlou A, Tariq L, Aziz F, El Hasnaoui A (2018) Prevalence of asthma among the adult general population of five Middle Eastern countries: results of the SNAPSHOT program. BMC Pulm Med 18(1):68. doi: 10.1186/s12890-018-0621-9.

Giraud V, Roche N (2002) Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Euro Respir J 19: 246-251.

Saunders KB (1965) Misuse of inhaled bronchodilator agents. Br Med J 1: 1037-1038.

Paterson IC, Crompton GK (1976) Use of pressurised aerosols by asthmatic patients. Br Med J 1(6001): 76-77.

Melani AS, Bonavia, Cilenti V, Cinti C, Lodi M, Martucci P, Serra M, Scichilone N, Sestini P, Aliani M. Neri M. (2011) Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med 105: 930-938.

McFadden ER (1995) Improper patient techniques with metered dose inhalers: Clinical consequences and solutions to misuse. J Aller Clin Immunol 96 (2): 278-283.

Self TH, Arnold LB, Czosnowski LM, Swanson JM, Swanson H (2007) Inadequate skill of healthcare professionals in using asthma inhalation devices. J Asthma 44(8): 593-598.

Laube BL, Janssens HM, de Jongh FHC, Devadason SG, Dhand R, Diot P, Everard ML, Horvath I, Navalesi P, Voshaar T, Chrystyn H (2011) ERS/ISAM Task force consensus statement: What the pulmonary specialist should know about the new inhalation therapies. Euro Respir J 37: 1308-1417.

Newman SP, Pavia D, Clarke SW (1980) Simple instructions for using pressurised aerosol bronchodilator. J Royal Soc Med 73: 776-779.

Hyland ME, Jones RC, Lanario JW, Masoli M (2018) The constriction and validation of the severe asthma questionnaire. Euro Respir J. 52(1): doi: 10.1183/13993003. 00618-2018.

Tarsin WY, Hshad NA, Elshamli I, Sherif FM (2019) A clinical benefit of training asthmatic patients on how to use metered dose inhalers by using the 2Tone trainer in Libya. J Pharm Pharmcol Res 3(2): 28-40.

Larsen JS, Hahn M, Ekholm B, Wick KA (1994) evaluation of conventional press-and-breathe metered-dose inhaler technique in 501 patients. J Asthma 31: 193-199.

Al-Showair RAM, Pearson SB, Chrystyn H (2007) The potential of a 2tone trainer to help patients use their metered-dose inhalers. Chest 131: 1776-1782.

Wilson-Pessano SR, McNabb WL (1985) The role of patient education in the management of childhood asthma. Prev Med 14(6): 670-687.

Crompton GK (1982) Terbutaline aerosol given through pear spacer in acute severe asthma. Br Med J 285:1205. doi:

Crompton GK (1990) The adult patient's difficulties with inhalers. Lung 168: S658-662.

Hilton S (1990) An audit of inhaler technique among asthma patients of 34 general practitioners. Br J Gen Pract 40: 505-506.

Nimmo CJ, Chen DN, Martinusen S, Ustad TL, Ostrow DN (1993) Assessment of patient acceptance and inhalation technique of a pressurized aerosol inhaler and two breath-actuated devices. Ann Pharmacother 27: 922-927.

Hesselink AE, Penninx BW, Wijnhoven HA, Kriegsman DM, Van eijk JT. (2001) Determinants of an incorrect inhalation technique in patients with asthma or COPD. Scand J Prim Health Care 19: 255-260.

Juniper EF, O'Byrne PM, Guyatt GH, Ferrie PJ, King DR (1999) Development and validation of a questionnaire to measure asthma control. Euro Respir J 14: 902-907.

How to Cite
Sherif, F. M., Walid Y. Tarsin, Nabila A. Hshad, Ishraq Elshamli, & Henry Chrystyn. (2019). An Assessment of Quality of Life in Libyan Patients with Bronchial asthma: a Clinical Benefit in using most Desirable Inhaler Techniques. International Journal For Research In Biology & Pharmacy (ISSN: 2208-2093), 5(6), 01-13. Retrieved from