Comparison of using corticosteroids metered dose inhaler with or without spacer in patients without coordination problems with uncontrolled or poorly controlled asthma, a randomized clinical trial

To evaluate the effectiveness of adding spacer to inhaled corticosteroid (ICS) in improving asthma control in patients with uncontrolled or poorly controlled asthma

The patient will be asked about the spray usage and the days of forgetting the ICS, and patients with proper adherence will be included in the study. The validated Asthma control test score is calculated for the patient, and if the score is less than 20, the patient is interviewed to enter the study, and then an informed consent form is obtained. Relevant demographic information, spirometry, patient medications, other diseases will be recorded. Patients are randomly assigned to one of two spacer or control groups.

All patients with asthma referred to the Pulmonary Clinic of Imam Khomeini Hospital will be examined. The attending physician will be blinded in this study (single blind).

Inclusion: 1. Adults over 18 to 65 years old with uncontrolled or poorly controlled asthma (ACT score < 20) 2. Using corticosteroid inhaler in the form of MDI (metered dose inhaler) for at least three months before starting the study. Exclusion: 1. tremors, Parkinson's or using medications that cause tremors 2. Neuro-cognitive problems that lead to incorrect use of the spray by the patient. 3. Non-adherence to medication 4. Dissatisfaction 5.. Having a critical error when using inhalation spray

1. Spacer group: A free of cost spacer is given to the patient to connect it to his/her corticosteroid inhaler to take the medicine with the spacer. Other treatments of the patient will be unchanged. 2. Control group: The patient's treatment will continue according to the doctor's opinion and without a spacer.

Asthma control test questionnaire score Forced vital capacity (FVC) forced expiratory volume in 1 second (FEV1) FEV1/FVC ratio

First, each patient is given a number from 1 to 114 with a computerized random number generation algorithm. These numbers are placed randomly in two spacer or control groups.

Due to the use of spacers in this study, the included patients will not be blinded to the intervention. The attending physician in this study will be blinded to the treatment of his patient in terms of receiving or not receiving a spacer. This means that the patient will be referred to the principal investigator, and then receive treatment according to the randomized group. Data analyzer will be blind to group assignment of patients.