WHAT DO PEDIATRICIANS IN-TRAINING KNOW ABOUT THE CORRECT USE OF INHALERS AND SPACER DEVICES

Most patients with asthma in the United Stares are cared for by nonspe cialist physicians. Because inhaled medications are the mainstay of as thma therapy and their successful use requires both practical skills a nd theoretic knowledge, we wondered how much nonspecialist physicians know about the use of metered-dose inhalers and spacer devices. Fifty pediatricians in training were interviewed individually. Practical kno wledge was assessed by asking each to demonstrate correct use of a pla cebo inhaler and a spacer device (Inspirease [Key Pharmaceuticals, Inc ., Miami, Fla.] and Aerochamber with mask [Monaghan Medical Corp., Pla ttsburgh, N.Y.]). Of the seven recommended steps for use of metered-do se inhalers, the residents demonstrated an average of 3.8 steps correc tly. The most common errors included not shaking the metered-dose inha ler before use (18% of residents correct) and insufficient breath hold ing (28% correct). In testing spacer use, the most common errors inclu ded not shaking the canister (16% correct) and incorrect number of act ivations and inhalations (12% correct). Many residents were not famili ar with correct assembly of the spacer (48% correct). Theoretic knowle dge of metered-dose inhaler and spacer use was evaluated by a written questionnaire. The most common deficiencies in theoretic knowledge rel ated to the purpose of slow inspiration and breath holding. Most of th e participants had been treating children with asthma and had prescrib ed metered-dose inhalers (45 of 50, 90%) and spacer devices (76%) in t he past. The results suggest that despite substantial involvement in a sthma management, pediatricians in training have significant inadequac ies in knowledge of the practical and theoretic aspects of metered-dos e inhaler and spacer use. Asthma specialists may need to fake a leadin g role in the development and implementation of educational programs a bout inhaled therapy.