The Extent of Patient’s Satisfaction Regarding Inhaler Counselling in the Kingdom of Saudi Arabia – A Cross-sectional Study

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Hafiz" }, { "@type": "Person", "name": "Yosra Alhindi" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Asthma is a common condition of chronic inflammation of the lower respiratory tract. Non-adherence to inhalation therapy and incorrect inhalation techniques is an important problem for optimal disease management. However, no previous studies have been conducted in Saudi Arabia to evaluate patient satisfaction with pharmacist counseling. Thus, we aim to study the extent of patient satisfaction with inhaler counseling and the factors associated with the appropriate use of inhaler techniques in Saudi Arabia. Methods A cross-sectional single-center face-to-face meeting survey was carried out between January to March 2024. That was conducted at Heraa General Hospital, Makkah, Saudi Arabia. We used a 16-item questionnaire by Counseling’s Satisfaction and Appropriate Use of Inhaler Technique (CSAUIT). Statistical analysis was performed using the chi-square test. P < 0.05 was considered statistically significant. All data were analyzed using Statistical Package for Social Sciences (SPSS). Results A total of 286 patients were included in the study. Of these, 118 (41.3%) were males, and 168 (58.7%) were females. The improper use of inhaler devices was observed in 179 (62.6%) of the patients, and the majority of patients (37.4%) were satisfied with pharmacist counseling. The majority of patients (60.50%) reported not receiving any explanation from the pharmacist as to why the inhaler was prescribed. A very low percentage of patients (16.8%) have been shown what to do when they forget a dose. About 95.9% of patients did not know the appropriate way to clean the inhaler device. An analysis based on education level found that participants holding a bachelor’s degree knew the correct use of inhaler devices as compared to participants in high school, and this difference was significant (P = 0.000). Conclusion This study showed that most patients were satisfied by pharmacist counseling about inhalers. However, the Inhaler technique among these patients was inadequate. 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F1000Research 2026, 15 :644 ( https://doi.org/10.12688/f1000research.178836.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article The Extent of Patient’s Satisfaction Regarding Inhaler Counselling in the Kingdom of Saudi Arabia – A Cross-sectional Study [version 1; peer review: awaiting peer review] Arwa Fairaq 1 , Amal Alagha 1 , Manal Abdulsatar 1 , Amin A Hafiz 2 , Halah A. Hafiz 2 , Yosra Alhindi https://orcid.org/0000-0002-5725-3522 3 Arwa Fairaq 1 , Amal Alagha 1 , [...] Manal Abdulsatar 1 , Amin A Hafiz 2 , Halah A. Hafiz 2 , Yosra Alhindi https://orcid.org/0000-0002-5725-3522 3 PUBLISHED 30 Apr 2026 Author details Author details 1 Pharmaceutical Practice Department, Umm Al-Qura University, Makkah, Saudi Arabia 2 Department of Clinical Nutrition, Umm A-Qura Universit, Makkah, Saudi Arabia 3 Department of Pharmacology and Toxicology, Umm A-Qura Universit, Makkah, Saudi Arabia Arwa Fairaq Roles: Conceptualization, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Amal Alagha Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Project Administration Manal Abdulsatar Roles: Conceptualization, Data Curation, Formal Analysis, Project Administration Amin A Hafiz Roles: Conceptualization, Data Curation, Formal Analysis, Writing – Original Draft Preparation Halah A. Hafiz Roles: Conceptualization, Formal Analysis, Writing – Review & Editing Yosra Alhindi Roles: Conceptualization, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW Abstract Background Asthma is a common condition of chronic inflammation of the lower respiratory tract. Non-adherence to inhalation therapy and incorrect inhalation techniques is an important problem for optimal disease management. However, no previous studies have been conducted in Saudi Arabia to evaluate patient satisfaction with pharmacist counseling. Thus, we aim to study the extent of patient satisfaction with inhaler counseling and the factors associated with the appropriate use of inhaler techniques in Saudi Arabia. Methods A cross-sectional single-center face-to-face meeting survey was carried out between January to March 2024. That was conducted at Heraa General Hospital, Makkah, Saudi Arabia. We used a 16-item questionnaire by Counseling’s Satisfaction and Appropriate Use of Inhaler Technique (CSAUIT). Statistical analysis was performed using the chi-square test. P < 0.05 was considered statistically significant. All data were analyzed using Statistical Package for Social Sciences (SPSS). Results A total of 286 patients were included in the study. Of these, 118 (41.3%) were males, and 168 (58.7%) were females. The improper use of inhaler devices was observed in 179 (62.6%) of the patients, and the majority of patients (37.4%) were satisfied with pharmacist counseling. The majority of patients (60.50%) reported not receiving any explanation from the pharmacist as to why the inhaler was prescribed. A very low percentage of patients (16.8%) have been shown what to do when they forget a dose. About 95.9% of patients did not know the appropriate way to clean the inhaler device. An analysis based on education level found that participants holding a bachelor’s degree knew the correct use of inhaler devices as compared to participants in high school, and this difference was significant (P = 0.000). Conclusion This study showed that most patients were satisfied by pharmacist counseling about inhalers. However, the Inhaler technique among these patients was inadequate. READ ALL READ LESS Keywords Asthma, Disease Management, Health Personnel, Patient Reported Outcome Measures, Pharmacists, Therapy., Community Corresponding Author(s) Yosra Alhindi ( [email protected] ) Close Corresponding author: Yosra Alhindi Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Fairaq A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Fairaq A, Alagha A, Abdulsatar M et al. The Extent of Patient’s Satisfaction Regarding Inhaler Counselling in the Kingdom of Saudi Arabia – A Cross-sectional Study [version 1; peer review: awaiting peer review] . F1000Research 2026, 15 :644 ( https://doi.org/10.12688/f1000research.178836.1 ) First published: 30 Apr 2026, 15 :644 ( https://doi.org/10.12688/f1000research.178836.1 ) Latest published: 30 Apr 2026, 15 :644 ( https://doi.org/10.12688/f1000research.178836.1 ) Introduction Asthma is a common condition of chronic inflammation of the lower respiratory tract. 1 It is a significant public health issue that poses a substantial economic burden. 2 Asthma is diagnosed based on respiratory symptoms of wheezing, cough, chest tightness, and/or dyspnea together with physiologic evidence of variable expiratory airflow limitation. 3 Nonadherence to inhalation therapy and incorrect inhalation technique is a significant challenge for optimal disease management. The general population showed unsatisfactory asthma control in Italy. 4 A study was conducted among asthma and COPD patients to educate them regarding proper adherence to inhaler techniques. It was found that before conducting the training program, the majority of patients (67.5%) were not adjusting well to the use of their inhalers. Personalized inhaler technique training was given for 24 weeks, after which the previous number dropped to 55% which was a considerable development. 5 Among hospitalized asthmatic patients in Jordan, better inhaler technique had been reported after training by a pharmacist. 6 As well as in Turkey, patient who waits in the outpatient clinic watching a presentation on the use of an inhaler device; provides significant benefits in device usage. 7 The same results have been reported in different countries including Japan, the United States of America, and India, as Inhaler usage skills significantly improved after inhalation education. 8 – 10 In Saudi Arabia, educational pharmaceutical pictograms have been reported to be a practical and affordable strategy that can help asthmatic patients utilize inhalers correctly. 11 Al Ammari et al. showed that the inhaler techniques in hospitalized Saudi patients with asthma and chronic obstructive pulmonary disease were inadequate. 12 Patients frequently make critical errors while using their inhalers resulting in difficulty and disease progression. These mistakes can easily be corrected through training and educational sessions. 13 Another study showed that inappropriate inhaler device use is linked to poor asthma control and more frequent visits to emergency rooms. 14 Furthermore, two studies reported that community pharmacists failed to demonstrate proper inhalation techniques in Al Qassim and Al-Ahsa region. 15 , 16 In addition, some studies reported inadequate levels of knowledge about pharmacotherapy of asthma and adherence to guidelines among pharmacists. 17 , 18 In the United Kingdom, pharmacists serve a crucial function at community pharmacies. Not only are they responsible for providing prescribed medications to patients, but they also aid them through improving their knowledge regarding the medications in addition to providing insightful guidance. 19 – 21 These community pharmacies contribute to a progressively coordinated approach towards asthma control and care for patients by referring and reviewing medication. This signifies the importance of the role of pharmacists in patient care and improving aspects of asthma care, the pharmacists of the US and UK are notable examples. 22 The significance of the role pharmacists play within their communities has been highlighted in this study, where disease control and inhaler use among the participants were tested before and after receiving thorough educational instructions from the pharmacists. This resulted in a clear improvement in inhaler usage among patients, however, most still made the common mistake of not exhaling before inhaling. 23 In a study conducted by Alhumam et al., 63.3% of physicians stated having demonstrated the correct usage of an inhaler device to caregivers at each visit. Additionally, the patient’s skill to properly use their inhaler was assessed by 46.7% of pharmacists. 42.2% of pharmacists recommended patients wash their spacer with warm water and detergent after each consecutive use. The disease to be treated with the prescribed inhaler was considered as the most important factor by 32.2% of the physicians. 24 To the best of our knowledge, there is very limited data available through studies previously conducted in Saudi Arabia to evaluate inhaler counseling by pharmacists. Thus, we aim to study the extent of patient satisfaction regarding inhaler counseling in the Kingdom of Saudi Arabia with a larger sample size than previously reported. Methods Study design A cross-sectional community-based face-to-face meetings was conducted at Heraa General Hospital, Saudi Arabia. From January to March 2024. Participants were randomly contacted and invited to complete an electronic questionnaire over four months. The questionnaire detailed the purpose of the study, and participants were informed that their involvement was voluntary. Questionnaire tool The questionnaire was adapted from a previous study by Katsurada et al. 8 Experts provided their feedback and opinions for improving the questionnaire, and their suggestions were incorporated into the final questionnaire, which contained 20 questions and was designed using online cloud-based questionnaire development software (Google Forms). The questionnaire was developed in English, translated into Arabic, the local spoken language, by proficient speakers of both languages and revised to suit the general population. Study population (Inclusion/Exclusion criteria) The selection criteria included adults (men and non-pregnant women) with acute and chronic respiratory diseases who took inhaler prescriptions. Exclusion criteria included pregnancy, incapacity to give informed permission, and concurrent major medical or surgical conditions requiring hospitalization. Consent 1- Written informed consent was obtained from all the participants. 2- Parental consents were obtained from parent/guardian of minors under 18 years old it was a written consent and they signed it. In addition to minor assent also written consent with their signature with voluntary participation and data privacy. Sample size and data collection The sample size was determined using Slovin’s formula on the basis of a population of A total of 286 patients with chronic diseases in Saudi Arabia, as reported in a recent study by Basheti et al. 6 The calculations were conducted with a confidence interval (CI) of 95% and a margin of error of 5%. The questionnaire was disseminated via social media platforms. After being downloaded from the Google Forms website, every questionnaire response was saved on a secure server. Participants who answered all questions in the survey were given a comprehensive case study of their responses. The responses of individuals who did not complete the questionnaire were excluded from the analysis. The information was gathered from the Google Forms spreadsheets and imported into Microsoft Excel. Data analysis and statistics The data were collected, reviewed, and input into the Statistical Package for Social Sciences version 26 (Released 2019. Armonk, NY: IBM Corp). All statistical methods used were two-tailed with an alpha level of 0.05 and were considered significant if the p-value was less than or equal to 0.05. We used Pearson’s Chi-Square and exact probability tests for small frequency distributions to measure any differences. Descriptive analysis for categorical data was performed using frequencies and percentages, and numerical data were presented as mean with standard deviation. Results Demographic characteristics Table 1 shows the frequency distribution of socio-demographic data. Among the participants, 36.0% of them were between the age group of 18 to 29 years, while only 9.8% of the participants were aged below 18 years. The majority of the participants, 58.7% were female, while only 41.3% were male. 43% of the participants held a bachelor’s degree, while only 6.6% of participants were at a Master’s education level. Moreover, most of the participants (76.9%) came from outside the medical field. 52.8% of the participants had Asthma disease, while 0.3% of participants reported being diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Only 25.9% of the participants reported having chronic diseases, out of which 76.09% of patients had hypertension, and 3.91% were diagnosed with rheumatoid arthritis. 64.7% of the participants used one inhaler, while 1.7% used three inhalers. The majority of participants, 69.2% used metered dose inhalers, while 6.3% of the participants used metered dose inhalers with a spacer. Table 1. Demographic characteristics of respond. Variable Number (%) Total 286 (100%) Gender Male 118 (41.3%) Female 168 (58.7%) Age (years) <18 28 (9.8%) 18–29 103 (36.0%) 30–39 53 (18.5%) 40–49 52 (18.2%) Equal or more than 50 50 (17.5%) Education level Less than high school 50 (17.5%) High school 94 (32.9%) Bachelor’s degree 123 (43.0%) Master and above 19 (6.6%) Are you in medical field? Yes 66 (23.1%) No 220 (76.9%) Do you have one of the following respiratory diseases? Asthma 151 (52.8%) Chronic obstructive pulmonary disease (COPD) 1 (0.3%) Allergy 45 (15.7%) No respiratory diseases 85 (29.7%) Others 4 (1.4%) Do you have any chronic disease? Yes 74 (25.9%) No 211 (74.1%) If your answer is yes, what diseases do you have? Hypertension 59 (76.09%) Cardiac disease 16 (12.50%) Diabetes Miletus 29 (22.66%) Kidney disease 7 (5.47%) Rheumatoid arthritis 5 (3.91%) Others 12 (9.38%) How many inhalers do you use? One 185 (64.7%) Two 96 (33.6%) Three 5 (1.7%) What type of inhaler do you use? Metered dose inhalers 198 (69.2%) Metered dose inhalers with spacer 18 (6.3%) Turbuhaler 62 (21.7%) HandiHaler 32 (11.2%) Diskus inhaler 33 (11.5%) Others 44 (15.4%) Table 2 shows the frequency distribution of patient counseling points. 68.9% of pharmacists explain the usage of inhalers however, 60.50% of pharmacists didn’t provide a thorough demonstration of the inhaler’s usage. Moreover, 69.6% of pharmacists didn’t inquire about any other medications the patients might be prescribed. 69.2% of pharmacists didn’t confirm patients’ allergies. Additionally, 74.8% of pharmacists neglected to provide instructions on when to stop using the inhaler. The majority of pharmacists, 83.2% don’t provide a solution for missed doses. Furthermore, 74.8% of pharmacists don’t warn patients regarding potential side effects that may be caused by to usage of inhalers. Table 2. Counselling points. Variable Number (%) Total 286 (100%) Dose the pharmacists explain how to use the inhaler? Yes 197 (68.9%) No 89 (31.1%) Dose the pharmacists explain why the inhaler given to you? Yes 113 (39.5%) No 173 (60.5%) Dose the pharmacist’s ask you “if you take other medication”? Yes 87 (30.4%) No 199 (69.6%) Dose the pharmacist’s ask you “if you have any allergy”? Yes 88 (30.8%) No 198 (69.2%) Dose the pharmacists explain when to stop the inhaler? Yes 72 (25.2%) No 214 (74.8%) Does the pharmacist explain what to do if you forget a dose? Yes 48 (16.8%) No 238 (83.2%) Dose the pharmacist explain to you what to do if you get a side effect from inhaler? Yes 72 (25.2%) No 214 (74.8%) Table 3 shows the frequency distribution of patient opinions about counseling. It was observed that 37.40% of the patients were satisfied with pharmacist counseling, while only 17.10% of the participants reported dissatisfaction. Moreover, 54.20% of the participants did not experience any barriers towards their pharmacists such as lack of confidence, privacy, or knowledge, during counselling, while 3.80% of the patients experienced that their pharmacist had a lack of self-confidence during counseling. 54.20% of participants thought their pharmacists had intermediary-level experience, while only 14.00% of the patients thought their pharmacists had zero experience. Patients who relied on their doctor’s explanation when the pharmacist didn’t provide adequate counsel made up 42.70%. Whereas 3.50% of patients consulted another pharmacist. Table 3. Patient opinion about the counselling. Are you Satisfied about pharmacists counselling? Very satisfied 55 (19.0%) Satisfied 107 (37.4%) Neutral 75 (26.2%) Not satisfied 49 (17.1%) What are the barriers do you encounter during the counselling? Lack of confidence 11 (3.8%) Lack of privacy 20 (7.0%) Lack of knowledge 20 (7.0%) Crowded 95 (33.2%) No barriers 155 (54.2%) Other 5 (1.7%) What do you think of the pharmacist’s experience? Good experience 90 (31.5%) Intermediate experience 156 (54.5%) No experience 40 (14.0%) If the pharmacist doesn’t counsel you on how to use the drug, what do you do? Ask the same pharmacist 110 (38.5%) Ask another pharmacist 10 (3.5%) Watch an educational video 64 (22.4%) Ask friends 20 (7.0%) Read leaflets 57 (19.9%) Rely on the doctor’s explanation 122 (42.7%) Table 4 shows the frequency distribution of correct usage of an inhaler. According to the data collected, 37.40% of patients were aware of the correct steps for using an inhaler. 56.60% of patients shake their inhaler device between puffs. Patients who held their breath while using the inhaler were found to be at 75.50%. The analysis revealed that 29.4% of participants always clean their inhalers while only 4.20% clean them with warm water. Table 4. Correct usage. Variable Number (%) Total 286 (100%) Select the correct steps of using the medication Wrong use1: Open the inhaler, breathe in, hold your breath (5 to 10 seconds), close the inhaler 93 (32.5%) Wrong use2: Open the inhaler, breathe in deeply through the inhaler, breathe out slowly, close the inhaler 86 (30.1%) Correct use: Open the inhaler, breathe out fully, breathe in deeply through the inhaler, hold your breath as long as possible (5 to 10 seconds), breathe out slowly, close the inhaler 107 (37.4%) Do you shake the inhaler between the puffs? Always 162 (56.6%) Sometimes 91 (31.8%) Never 33 (11.5%) Do you hold your breath when you use the medication? Yes 216 (75.5%) No 70 (24.5%) How often do you clean the inhaler device? Always 84 (29.4%) Sometimes 109 (38.1%) Never 93 (32.5%) How do you clean the inhaler device? Hot water 120 (42.0%) Warm water 12 (4.2%) Cold water 56 (19.6%) I don’t clean the device 68 (23.8%) Paper tissue 30 (10.5%) Part One: The relationship between selected socio-demographic variables and counselling points Table 5 demonstrates the relationship between patient’s opinions regarding their counseling and age group. Only two relationships were found to be statistically significant, firstly, patients watched an educational video (p = 0.036), and second where patients relied on the doctor’s explanation (p = 0.00). However, there were no other statistically significant relationships between other opinions on counseling and age group. Table 5. The relationship between patient opinion about the counselling and Age. Age* patient opinion about the counselling Age group Percentage % NO. Patient Chi-square (p-Value) Ask the same pharmacist < 18 3.8% 11 0.654 18–29 12.9% 37 30–39 8.0% 23 40–49 8.0% 23 ≥ 50 5.6% 16 Ask another pharmacist < 18 0.0% 0 0.681 18–29 1.4% 4 30–39 0.3% 1 40–49 1.0% 3 ≥ 50 0.7% 2 Watch an educational video < 18 3.1% 9 0.036 18–29 9.4% 27 30–39 4.5% 13 40–49 4.2% 12 ≥ 50 1.0% 3 Ask friends < 18 1.0% 3 0.551 18–29 2.4% 7 30–39 1.7% 5 40–49 1.4% 4 ≥ 50 0.3% 1 Read leaflets < 18 0.3% 1 0.089 18–29 9.4% 27 30–39 2.8% 8 40–49 3.8% 11 ≥ 50 3.5% 10 Rely on the doctor’s explanation < 18 7.3% 21 0.000 18–29 8.0% 23 30–39 10.8% 31 40–49 9.1% 26 ≥ 50 7.3% 21 Table 6 demonstrates the relationship between patient’s opinions regarding their counseling and their education level. In this category, 2 statistically significant relationships were observed: Reading leaflets (p = 0.00) and Relied on the doctor’s explanation (p = 0.00). However, there was no statistically significant relationship between other items of patient opinion about counseling and education level. Table 6. The relationship between patient opinion about the counselling and Education level. Education level * patient opinion about the counselling Education level Percentage % NO. Patient Chi-square (p-Value) Ask the same pharmacist Less than High school 8.0% 23 0.051 High school 12.2% 35 Bachelor’s degree 17.5% 50 Master and above 0.7% 2 Ask another pharmacist Less than High school 0.0% 0 0.340 High school 1.4% 4 Bachelor’s degree 2.1% 6 Master and above 0.0% 0 Watch an educational video Less than High school 3.5% 10 0.654 High school 8.0% 23 Bachelor’s degree 8.7% 25 Master and above 2.1% 6 Ask friends Less than High school 1.4% 4 0.971 High school 2.4% 7 Bachelor’s degree 2.8% 8 Master and above 0.3% 1 Read leaflets Less than High school 0.7% 2 0.000 High school 4.2% 12 Bachelor’s degree 13.3% 38 Master and above 1.7% 5 Rely on the doctor’s explanation Less than High school 12.6% 36 0.000 High school 16.1% 46 Bachelor’s degree 11.2% 32 Master and above 2.8% 8 Part Two: The relationship between selected socio-demographic variables and correct usage of inhaler Table 7 displays the relationship between correct usage of inhaler devices and age group. There was a statistically significant relationship between age group and only 3 items of correct usage: Select the correct steps of using the medication (p = 0.010), Do you hold your breath when you use the medication? (p = 0.018), How often do you clean the inhaler device? (0.007). Table 7. The relationship between Correct usage and Age. Age* Correct usage Age group Percentage % NO. Patient Chi-square (p-Value) Correct use < 18 1.4% 4 0.010 18–29 18.2% 52 30–39 5.6% 16 40–49 5.9% 17 ≥ 50 6.3% 18 Wrong use 1: < 18 3.1% 9 18–29 10.5% 30 30–39 6.3% 18 40–49 5.9% 17 ≥ 50 6.6% 19 Wrong use 2: < 18 5.2% 15 18–29 7.3% 21 30–39 6.6% 19 40–49 6.3% 18 ≥ 50 4.5% 13 Do you hold your breath when you use the medication? Yes < 18 5.9% 17 0.018 18–29 26.6% 76 30–39 13.6% 39 40–49 16.8% 48 ≥ 50 12.6% 36 How often do you clean the inhaler device? Always (correct) < 18 2.8% 8 0.007 18–29 7.0% 20 30–39 5.2% 15 40–49 7.3% 21 ≥ 50 7.0% 20 Sometimes < 18 4.2% 12 18–29 17.5% 50 30–39 4.5% 13 40–49 4.9% 14 ≥ 50 7.0% 20 Never < 18 2.8% 8 18–29 11.5% 33 30–39 8.7% 25 40–49 5.9% 17 ≥ 50 3.5% 10 Discussion Asthma is a common condition due to chronic inflammation of the lower respiratory tract. 1 Chronic lower airway inflammation is known to be more common in individuals who also have inflammatory disorders of the upper airway, so this research was conducted to evaluate the knowledge and inhaler counseling of patients with asthma disease. 2 The findings in the present study are consistent with the findings of another investigator Alfadl et al. 25 suggesting that a low percentage of the patients were asked about the indication of the medication, drug interactions, precautions while using the drug, and common side effects that patients may experience. There are similarities regarding counseling points are found to be below acceptable standards between the present study and those described by Alfadl et al. 25 Contrary to expectations, research described by Dhand et al. finds that most patients do not clean the inhaler device, while in our study, most patients cleaned their inhaler device. 26 Another study mentions that patients often find it inconvenient to regularly clean their inhalers, they prefer Dry Powder Inhalers (DPI) over metered-dose inhalers (pMDIs) because DPIs require much less cleaning. 27 In a study conducted by Basheti et al., 6 they reported the majority of patients were provided proper information on the correct usage of their inhalers, whereas in this study the opposite was observed. The results of the study described by Basheti et al. 6 show that most patients believed that it was the respiratory specialist’s role to educate them on asthma and inhaler techniques, and only a few believed it was the pharmacist’s role. These findings are consistent with our data that most patients rely on their doctor’s explanations, and few ask the pharmacist for counseling. 6 Considering previous studies, it was not surprising that Basheti et al. discovered that patients’ primary source of inhaler technique instruction before this point was their specialist, with the pharmacist having a minimal impact. 6 The current study found a statistically significant relationship between selected socio-demographic variables and Counselling points that correspond to Basheti et al. 6 and Ammari et al. 12 The present study aligns with earlier research, which commonly suggests the need for further investigations into the evaluation of patient knowledge and the provision of inhalation counseling for individuals with asthma. The study highlighted the crucial role of pharmacists in providing comprehensive education on inhalation therapy, including the causes, proper usage techniques, and potential side effects. This aligns with the findings of Alghadeer et al., 28 who emphasized the importance of regular pharmacist consultations to ensure patient reassurance and stressed that pharmacists should take full responsibility for offering guidance and advice. Similarly, in studies by Spencer et al. 29 and Caminati et al. 4 reported comparable outcomes, reinforcing the pharmacist’s role in patient education and support. Khan et al. 16 highlighted the critical need for patients to be adequately informed about proper inhaler use. The findings also revealed that some pharmacists lack the necessary knowledge to effectively explain inhaler techniques and their potential effects to patients. This knowledge gap can result in patients losing trust in their pharmacists as health personnel. Another study reviewing past research revealed how only 15.5% of healthcare professionals knew how to properly use inhalers and, therefore cannot be responsible for correctly demonstrating their use to patients. 30 , 31 Findings of these studies contradict the results of our current study, which found that there is good knowledge by pharmacists of inhalers, and they are providing sufficient care and information to the patients. Majority of patients. 107 (37.4%) were satisfied with the counseling provided by their pharmacists. The study of Adnan et al. showed there is a gradual improvement in providing information by pharmacists about the handling of MDI as compared to earlier studies in the region. 15 The study’s results were presented in two key sections. In the first, the relationship between two socio-demographic factors—age and education level—and patients’ preferences for counseling methods was examined. A significant association was found between age and the preference for receiving counseling through educational videos (p = 0.036), as well as between age and relying solely on the doctor’s explanation (p = 0.00). Regarding education level, a strong correlation was noted between higher education and obtaining counseling from leaflets (p = 0.00), along with patients with higher education levels also relying on doctor-provided counseling (p = 0.00). The second part of the study explored the connection between proper inhaler use and two socio-demographic factors: age and education level. A significant relationship was found between age and correct inhaler usage (p = 0.010), as well as between age and actions like holding one’s breath while taking the medication (p = 0.018) and cleaning the inhaler (p = 0.007). Similarly, education level showed a significant correlation with correct inhaler use (p = 0.000) and holding breath while using the inhaler (p = 0.003). However, no statistically significant link was observed between education level and cleaning the inhaler device. In contrast, there was a significant relationship between certain aspects of patient opinions on counseling and inhaler use based on the age of the patients. Additionally, there was a connection between various counseling points and patient opinions on counseling, as well as correct inhaler usage in relation to the patient’s level of education. This study was conducted to evaluate the impact of pharmacist counseling on the incorrect use of inhalers. The findings suggest that pharmacists should dedicate more time to patient counseling to improve medication adherence. This study had several strengths. Notably, the sample size was substantial, and data collection was conducted face-to-face, enhancing the reliability of responses. Additionally, this study is unique in including the assessment of inhaler cleaning practices, an often-overlooked aspect of inhaler use. However, the study has some limitations. Patients were not asked to demonstrate their inhaler technique, and the findings were based solely on self-reported data. Furthermore, the study was limited to Heraa General Hospital in Mecca. Expanding the research to a national level would yield more comprehensive insights into pharmacists’ counseling practices across different regions. Conclusion This study aimed to assess the impact of pharmacist counseling on the proper use of inhalers among asthma patients, with a focus on evaluating knowledge and counseling practices. The findings reveal that while pharmacists in the study demonstrated good knowledge of inhaler use, there is a need for more consistent and comprehensive patient counseling to enhance medication adherence and correct inhaler techniques. This study also showed that the majority of patients were satisfied by pharmacists’ counseling regarding inhalers; however, the inhaler technique among these patients was inadequate. Ethical approval Approval was obtained from Umm Al-Qura University medical college committee with the IRB Approval number (HAPO-02-K-012-2023-01-1421). Written informed Consent was obtained from all participants who answered the survey questions. Moreover, consents were obtained from parent/guardian of minors under 18 years old in addition to minor assent Al with voluntary participation and data privacy, the study was adhered to the principles stated in the ‘Declaration of Helsinki’. Acknowledgments We would like to thank the staff at Heraa General Hospital. Dr Hisham Al-Harbi is gratefully acknowledged for his support in data collection. Data availability statement Zenodo. The Extent of Patient’s Satisfaction Regarding Inhaler Counselling in the Kingdom of Saudi Arabia – A Cross-sectional Study. https://doi.org/10.5281/zenodo.19023190 32 This project contains the following underlying data: • Inhaler data. (Data contains raw data and statistics of the study results). • english_100_clean.xlsx Data is available under the terms of the [ Creative Commons Attribution 4.0 International ( CC BY 4.0 )]. Extended files Zenodo. survey and consent form. https://doi.org/10.5281/zenodo.19023436 33 This project contains the following underlying data: • Extended data. (Data contains survey and consent form of the study results). • Consent_Form.docx Data is available under the terms of the [ Creative Commons Attribution 4.0 International ( CC BY 4.0 )]. References 1. Hammad H, Lambrecht BN: The basic immunology of asthma. Cell. 2021; 184 (6): 1469–1485. Publisher Full Text 2. López-Tiro J, Contreras-Contreras A, Rodríguez-Arellano ME, et al. : Economic burden of severe asthma treatment: A real-life study. World Allergy Organ J. 2022; 15 (7): 100662. PubMed Abstract | Publisher Full Text | Free Full Text 3. Sockrider M, Fussner L: What is asthma?. Am J Respir Crit Care Med. 2020; 202 (9): P25–P26. 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Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 30 Apr 2026 ADD YOUR COMMENT Comment Author details Author details 1 Pharmaceutical Practice Department, Umm Al-Qura University, Makkah, Saudi Arabia 2 Department of Clinical Nutrition, Umm A-Qura Universit, Makkah, Saudi Arabia 3 Department of Pharmacology and Toxicology, Umm A-Qura Universit, Makkah, Saudi Arabia Arwa Fairaq Roles: Conceptualization, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Amal Alagha Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Project Administration Manal Abdulsatar Roles: Conceptualization, Data Curation, Formal Analysis, Project Administration Amin A Hafiz Roles: Conceptualization, Data Curation, Formal Analysis, Writing – Original Draft Preparation Halah A. Hafiz Roles: Conceptualization, Formal Analysis, Writing – Review & Editing Yosra Alhindi Roles: Conceptualization, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 30 Apr 2026, 15:644 https://doi.org/10.12688/f1000research.178836.1 Copyright © 2026 Fairaq A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. 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