Inhalers Of Today: How Hard Are They To Use?

Introduction Self-administered inhalation therapy is the cornerstone for optimal long-term treatment of asthma and chronic obstructive pulmonary disease (COPD). The variety of inhalation devices and inhalation techniques is a common cause of confusion for patients. This translates to reduced medication compliance and ultimately inadequate disease control. To resolve this problem, national and international guidelines have stressed patient education as a fundamental part of airway disease management. In spite of this, healthcare professionals who prescribe these devices are themselves often not equipped to efficiently educate patients on proper inhalation technique. The purpose of this study was to evaluate various healthcare providers in their knowledge of and ability to use specific inhalation devices. Methods Healthcare providers, which include physicians (MD), pharmacists (PharmD), respiratory care practitioners (RCP), and nurses (RN) who regularly prescribe inhalation devices or educate patients regarding the correct use of inhalation devices, were included. Baseline proficiency was evaluated by assessing the subjects' knowledge of and ability to use four common inhaler devices: Spiriva HandiHaler(registered trademark) (Boehringer Ingelheim), Advair Diskus(registered trademark) (GlaxoSmithKline), ProAir HFA(registered trademark) (Teva) and Pulmicort Flexhaler(registered trademark) (AstraZeneca). Subjects were asked to demonstrate proper inhalation technique for each device using placebo inhalers and to answer 20 clinically relevant questions related to the use and maintenance of the tested device. Results Twenty-one subjects (6 MD, 5 PharmD, 6 RCP, and 4 RN) completed the baseline proficiency tests. As a group, the subjects' performance was as follows: knowledge score percent mean 63 (plus or minus) 16 and practicum test percent mean 74 (plus or minus) 16. Separating the series by decreasing score order and profession revealed a percent mean knowledge score of 78 (plus or minus) 13 percent for pharmD, 64 (plus or minus) 15 percent for RCP, 56 (plus or minus) 12 percent for MD, and 53 (plus or minus) 17 percent for RN. Percent mean practicum scores were 86 (plus or minus) 6 percent for PharmD, 82 (plus or minus) 16 percent for RCP, 65 (plus or minus) 13 percent for MD, and 62 (plus or minus) 15 for RN. Conclusion In this preliminary report, we find an overall suboptimal knowledge base and technical skill level on the use of modern inhalers. This could potentially impact how accurate patients utilize and maintain their inhalers. A larger study with follow-up testing is ongoing.