Chest
Volume 105, Issue 1, January 1994, Pages 111-116
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Clinical Investigations: Asthma
Medical Personnel's Knowledge of and Ability to Use Inhaling Devices: Metered-Dose Inhalers, Spacing Chambers, and Breath-actuated Dry Powder Inhalers

https://doi.org/10.1378/chest.105.1.111Get rights and content

Background

Current treatment strategies for asthma and chronic obstructive pulmonary disease (COPD) emphasize the inhalation route, yet patients often misuse metered-dose inhalers (MDI). To address this problem, patient education by medical personnel has been recommended and a variety of alternate inhaler devices have been developed.

Methods

We surveyed medical personnel to assess their knowledge of and ability to use three widely used inhaler devices; MDI, MDI with a spacing chamber (Aerochamber, Trudell Medical, Canada), and a breath-actuated multidose dry powder inhaler (Turbuhaler, Astra Pharmacy, Inc., Conada). Thirty respiratory therapists (RT), 30 registered nurses (RN), and 30 medical house staff physicians (MD) were asked to demonstrate the use of each device using placebo inhalers and to answer 11 clinically relevant questions related to the use and maintenance of the tested devices.

Results

The RT's percent mean knowledge score (67 ± 5 percent) was significantly higher than those achieved by either the RNs (39 ± 7 percent) or the MDs (48 ± 7 percent) (for all p < 0.0001). Similarly, percent mean demonstration scores for each device were significantly higher for RTs than either RN or MD groups; for MDI, 97 ± 3 percent versus 82 ± 13 percent and 69 ± 24 percent, respectively (p < 0.0001); for the Aerochamber, 98 ± 2 percent versus 78 ± 20 percent and 57 ± 31 percent (p < 0.0001); and for the Turbuhaler, 60 ± 30 percent versus 12 ± 23 percent and 21 ± 30 percent (p < 0.0001). Knowledge of and practical skills with the devices were roughly proportional to the length of time the device had been in clinical use, Turbuhaler demonstration scores being lower than either MDI or Aerochamber scores (p = 0.05 and p = 0.09, respectively). More RTs (77 percent) had received formal instruction on the use of devices at school than either RNs (30 percent) or MDs (43 percent) (p < 0.05).

Conclusion

We conclude that (1) many medical personnel responsible for monitoring and instructing patients in optimal inhaler use lack rudimentary skills with these devices, (2) nurses and physicians seldom receive formal training in the use of inhaling devices, and (3) newer inhaling devices designed to obviate problems of technique are at present less likely to be used well by medical personnel soon after their introduction.

Section snippets

Subjects

The study was performed at The Toronto Hospital (a tertiary care university-based hospital). Thirty respiratory therapists (RTs), 30 registered nurses (RNs) working on the medical and respiratory wards, and 30 medical house staff physicians (MDs) (internal medicine residents and interns) were asked to participate. All medical personnel enrolled were involved in the daily care of patients and prescribed, administered, or dispensed the inhaler devices being assessed. Participants were contacted

Results

Percent mean scores ± SD for each group and each device are listed in Table 3.

Discussion

During the last few years, emphasis has been made on the important role played by medical professionals in repeatedly instructing and monitoring patients for the optimal use of inhaled medication delivery devices.19, 20 However, our data show that many of these medical personnel lack rudimentary skills with these devices and many lack elementary theoretic knowledge about their use. Of the medical and paramedical groups tested, house staff and nurses seem least likely to use inhaling devices

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