Results of a programme to improve house staff use of metered dose inhalers and spacers

Abstract

Postgrad Med J 2003;79:221-225 Purpose: Metered dose inhalers (MDIs) and spacers are used widely in the treatment of asthma. Medical personnel who are responsible for training patients must themselves be proficient with the devices. The proficiency of a group of new medical interns with use of MDI and spacer devices was determined, and improvement in their use of these devices was sought. Subjects: Fifty six medical interns tested at the start of their first house staff training year. Methods: The ability of medical interns to use MDIs and spacers was assessed using a visual scoring system before and after a large group lecture emphasising proper device use and once again after an intensive one-on-one training session with an attending physician. Results: Initially, only 5% used an MDI perfectly. This improved to 13% after a lecture and demonstration, and 73% after an intensive one-on-one session. Almost no new interns could use a collapsible or tube spacer properly initially. This improved to 15% and 29% respectively after a lecture. After oneon-one training, correct technique was increased to 69% for collapsible spacer and 95% for the tube spacer. Analysis of individual steps of MDI use showed that interns had particular difficulty in coordinating actuation with inhalation. The tube spacer appeared easiest to learn. Conclusions: Incoming medical house staff have limited ability to use MDI with and without spacers. A large group lecture is relatively ineffective when compared with a one-on-one training session in training with these devices.

Misuse of Inhalation Devices-Effective Parameters and the Role of Education

“…İnhaler cihaz kullanım tekniği hastalara mutlaka öğretilmeli-dir. Prospektüs veya broşür ile öğrenen hastaların doğru şekilde kullanabilme oranları çok düşüktür (21,24,27). Bu eğitimin; hemşire, eczacı veya aile hekimine kıyasla, ilacı yazan göğüs hastalıkları uzmanı tarafından verilmesi doğru kullanım açısın-dan daha önemlidir.…”

A Randomized Controlled Trial of a Literacy-Sensitive Self-Management Intervention for Chronic Obstructive Pulmonary Disease Patients

“…This inhaler technique checklist was developed due to a lack of consensus in the literature on what items should be assessed for various inhaler techniques. Our checklist is based on technique descriptions from product package inserts, expertise of the study investigators in what items should be included, and a review of the literature of previously used inhaler technique checklists, including national guidelines 10,[21][22][23][24][25][26][27][28][29] . The checklists are each comprised of eight items which were assessed as appropriate for the use of the inhaler and were all necessary elements and to keep each as discrete, assessable items.…”

“…It uses health-related materials such as consent forms to assess participant's ability to understand written materials. Scores for the S-TOFHLA range from 0 to 36 and are categorized as inadequate literacy (0 to 16), marginal literacy [17][18][19][20][21][22] , and adequate literacy (23 to 36). For the purposes of our study, we combined the marginal and inadequate groups to form our low literacy group (those with a score from 0 to 22).…”

Evaluation and importance of different types of inhaler device in patients with chronic obstructive lung disease

“…Van der Palen et al conducted a randomized controlled trial in 152 COPD patients and applied three different models of education and determined that explaining the patients how to apply the drug by medical staff alone is more efficient and that education via video as well gives good results (29). In the study conducted by Lee-Wong and Mayo, the rate of appropriate application of MDI devices was 5% among new medical interns, whereas it increased to 13% after lecture and demonstration and to 73% after intensive one-on-one training session with an attending physician (30). Effect of education on appropriate application of devices is not a matter of debate.…”