Proper Use Of Metered-dose Inhaler Research Articles

Correlation of Metered Dose Inhaler Use Technique and Asthma Control Level in Asthma Patients at a Hospital in Bandung, West Java, Indonesia

Background: Asthma is still a major health problem in global population, including Indonesia. Antiasthma drugs available in various dosage forms, including inhaler. However, several problems related to inhalation route were found due to its unique device form and spesific use technique. One of the major problems related to inhalation route is inappropriate use technique of inhaler device, which could lead to treatment failure. Therapy outcome can be measured through Asthma Control Test (ACT). Objectives: This study was aimed to evaluate correlation between metered dose inhaler (MDI) use technique and asthma control level in patients. Material and Methods: A cross-sectional analytic study was conducted in May - June 2021. Thirty patients who met inclusion criteria were enrolled in this study. Patients’ MDI use technique and asthma control level were evaluated using a valid and standardized questionnaire. Statistics analysis was performed to determine the correlation between MDI use technique and asthma control level. Results: This study showed that most of asthmatic patients were women in older age, with mild asthma severity for more than 10 years. The most prevalent medication used was Fenoterol HBr, followed by salbutamol, and salmeterol/fluticasone combination. Inappropriate MDI use was found in 70,0% patients, with major problem found in patients’ breathing technique before and during MDI use. Asthma control test was performed and showed that 90,0% of asthmatic patients involved in this study have an uncontrolled asthma. Statistical analysis using Pearson product-moment correlation test showed a positive correlation between proper use of MDI and asthma control level (r=0.425, p<0.05). Conclusions: Patient who properly use MDI may have a higher score in asthma control test, thus have a better control of asthma. This study emphasized pharmacist role as patient educator in ensuring appropriate inhaler use in order to achieve therapeutic goals.

Improving Resident Knowledge of Spacers.

Studies show the delivery of inhaled medications is maximized when a metered-dose inhaler (MDI) with a spacer is utilized. Our residents expressed concern with their knowledge of MDIs and spacers. This study was designed to address those concerns. Residents were given a 12-question pre-intervention, self-assessment questionnaire that explored their overall knowledge and comfort in utilizing MDI with spacers. Participants then received educational intervention via multimedia videos and a demonstration of proper use of MDI with spacer. Participants were given the same questionnaire immediately following the education and again 3 months later. Improvement was significant (P < .05) for each element studied as derived from the 12 questions. Improvement remained significant when these variables were assessed in the 3-month follow-up. In this study, we successfully improved the ability of our residents to deliver quality care by improving their knowledge and confidence in utilizing MDIs with spacers.

Proficiency of Pediatricians in the Use of Inhaled Medication Delivery Systems for the Management of Asthma

Objective: To evaluate the proficiency of pediatricians in the demonstration of the proper use of metered-dose inhalers (MDIs) and to assess their theoretical knowledge of inhalation devices used in the management of asthma. Design: Prospective cross-sectional survey. Setting: Two university-affiliated hospitals. Participants: Seventy-one pediatricians and pediatric house staff. Intervention: Each pediatrician's technique was graded by two trained observers using a checklist of six essential steps recommended by national guidelines. Theoretical knowledge of asthma devices was evaluated by a written questionnaire. Results: Twenty (35.2%) pediatricians performed at least five steps correctly, 28 (39.4%) performed three or four steps correctly, and 18 (25.4%) performed two steps or less correctly. The most common errors were failure to start inhalation from functional residual capacity, failure to inhale slowly, and failure to wait at least 20 seconds before the next puff. Senior pediatricians were more skillful in the practical use of MDIs than were pediatric house staff (p = 0.03). The most common deficiencies in theoretical knowledge were related to estimation of the amount of medication in the canister (8.5% correct) and how valved holding chambers (VHCs) improve drug delivery to the lung (15.5% correct). Conclusion: Pediatricians in Kuwait have significant deficiencies regarding the practical and theoretical aspects of MDIs and other inhalation devices.

Metered-Dose Inhalers: Do Emergency Health Care Providers Know What to Teach?

Study objective: To evaluate the ability of emergency health care providers and patients to demonstrate the proper use of metered-dose inhalers (MDIs). Design: Prospective cross-sectional survey. Setting: Five Midwestern community teaching hospitals. Participants: One hundred eighty-five health care providers, comprising emergency medicine house staff (n=60), attending emergency physicians (n=50), and ED nurses (n=75). Also recruited were 100 consecutive ED patients with clinical history of asthma being treated with at least one MDI for more than 3 months. Interventions: We surveyed patients and health care providers to assess their knowledge of and ability to use a conventional MDI. The subject's technique of using a placebo inhaler was graded by a trained observer using a checklist of six essential steps. Results: Forty-one percent (76 of 185) of health care providers and 49% (49 of 100) of ED asthma patients performed at least five steps correctly (P =.24). There were no significant differences in performance scores among the emergency medicine house staff (42%), attending emergency physicians (34%), and ED nurses (45%). Only 15% of all health care providers and 17% of asthma patients were able to describe how to estimate the amount of medicine left in the canister. Conclusion: These results suggest that many patients use MDIs improperly. Emergency physicians, house staff, and nurses responsible for instructing patients in optimal inhaler use may lack even rudimentary skills with these devices. [Jones JS, Holstege CP, Riekse R, White L, Bergquist T: Metered-dose inhalers: Do emergency health care providers know what to teach? Ann Emerg Med September 1995;26:308-311.]

Metered-Dose Inhalers: Mouth Open or Closed?

To the Editor. —For the last several weeks you have published an advertisement for Tilade (nedocromil sodium, Fisons Corporation, Rochester, NY).1On the third page of this insert is a photograph of a man using this metered-dose inhaler (MDI)—incorrectly. Metered-dose inhalers work better, in general, with a mechanical spacer or a 2-cm gap between the outlet and the lips. Using the inhaler as pictured, with the device jammed inside the mouth, results in deposition of the medication on the posterior pharynx rather than in the lungs. Physicians readingThe JOURNALshould teach proper use of MDIs and not as pictured.

Pharmacists are health care providers too

In a recent article, entitled Metered-Dose Inhalers: Do Health Care Providers Know What to Teach?, Interiano and Guntupalli 1 evaluated the correct use of metered-dose inhalers (MDIs) by patients, physicians, respiratory care practitioners, and nurses. The authors concluded that a significant proportion of health care providers (ie, internal medicine physicians, pulmonary fellows, nurses, and respiratory therapists) who interact directly with asthma patients were inadequately trained concerning MDIs. Guidry et al 2 published a similar study in 1992. In both studies, pharmacists were absent from the list of health care providers. Pharmacists are another significant health care provider with adequate training on patient counseling and use of MDIs. The responsibility of educating patients on the proper use of MDIs may be placed on other health care professionals (ie, pharmacists, nurses, and respiratory therapists). Guidry et al 2 believed that respiratory therapists or registered nurses would have a prominent role. Actually, pharmacists

Can the Nebulizer Survive?

The excellent article by Skorodin¹detailed many current aspects of thinking, practices, and controversies in the treatment of asthma and chronic obstructive pulmonary disease. It is apparent that he is cost-conscious and thorough in his approach. Our original belief, shared by many others,²was that we could train and educate patients in proper use of metereddose inhalers. However, after two decades of trying, we now believe that all patients with chronic obstructive pulmonary disease and asthma deserve their own personal aerosol reservoir to bring with them to the emergency department, ward, intensive care unit, spinal cord unit, or any other part of the hospital.^3-6 We will still need a few nebulizers for sputum induction, but the new developments in aerosol reservoir technology and delivery systems (masks and adapters) have made it almost impossible for us to identify a patient who requires the costly and inefficient, cumbersome nebulizer

Metered-Dose Inhalers

<h3>Objective:</h3> The specific aim of this investigation was to evaluate the proficiency of health care providers and patients in the proper use of metered-dose inhalers. <h3>Design, Setting, and Participants:</h3> Health care providers, which include house staff, nurses, and respiratory care practitioners who provide care to patients with asthma in the primary general medicine clinic or the pulmonary medicine clinic of a university-county hospital in which patients were referred, were surveyed and assigned a performance score regarding the knowledge base of the appropriate use of metered-dose inhalers. Patients who attended the primary care general medicine and pulmonary subspecialty clinic were also assessed as to their proficiency in the use of metered-dose inhalers. <h3>Results:</h3> A significant percentage of patients had a poor understanding of the technique used with the metered-dose inhaler. House staff and nursing staff were also less proficient in the proper use of the metered-dose inhaler. The respiratory care practitioners were the most knowledgeable of the health care providers. <h3>Conclusions:</h3> This study confirms that a large percentage of patients use metered-dose inhalers improperly. It also demonstrates a significant lack of understanding by health care providers of the proper use of metered-dose inhalers. Furthermore, this study supports the use of respiratory care practitioners in the outpatient setting, since they were the most proficient among all the health care providers in the proper use of metered-dose inhalers. (Arch Intern Med. 1993;153:81-85)

Metered-dose inhalers. Do health care providers know what to teach?

The specific aim of this investigation was to evaluate the proficiency of health care providers and patients in the proper use of metered-dose inhalers. Health care providers, which include house staff, nurses, and respiratory care practitioners who provide care to patients with asthma in the primary general medicine clinic or the pulmonary medicine clinic of a university-county hospital in which patients were referred, were surveyed and assigned a performance score regarding the knowledge base of the appropriate use of metered-dose inhalers. Patients who attended the primary care general medicine and pulmonary subspecialty clinic were also assessed as to their proficiency in the use of metered-dose inhalers. A significant percentage of patients had a poor understanding of the technique used with the metered-dose inhaler. House staff and nursing staff were also less proficient in the proper use of the metered-dose inhaler. The respiratory care practitioners were the most knowledgeable of the health care providers. This study confirms that a large percentage of patients use metered-dose inhalers improperly. It also demonstrates a significant lack of understanding by health care providers of the proper use of metered-dose inhalers. Furthermore, this study supports the use of respiratory care practitioners in the outpatient setting, since they were the most proficient among all the health care providers in the proper use of metered-dose inhalers.