Cjr. Nimmo et al., ASSESSMENT OF PATIENT ACCEPTANCE AND INHALATION TECHNIQUE OF A PRESSURIZED AEROSOL INHALER AND 2 BREATH-ACTUATED DEVICES, The Annals of pharmacotherapy, 27(7-8), 1993, pp. 922-927
OBJECTIVE: To assess inhalation technique in patients after written in
struction alone, written and verbal instruction, and clinical use of t
wo new inhalation devices. DESIGN: Randomized, crossover evaluation of
the albuterol Diskhaler and the terbutaline Turbuhaler. SETTING: Cana
dian tertiary-care hospital. PATIENTS: Twenty hospitalized adults with
asthma or chronic obstructive pulmonary disease currently using an al
buterol metered-dose inhaler (MDI). Nineteen patients received Diskhal
er, 16 received Turbuhaler, 15 received both inhalers, and 10 patients
used both inhalers for three days each. INTERVENTIONS: Patients were
randomized to receive either Diskhaler or Turbuhaler for three days. I
nhaler technique was assessed after written instruction, written plus
verbal instruction, at the first scheduled dose after instruction, and
after three days of clinical use. Patients remaining in the hospital
after three days crossed over to the other study inhaler and the same
protocol was followed. MAIN OUTCOME MEASURES: Patient inhalation techn
ique was assessed and compared for the MDI, Diskhaler, and Turbuhaler.
RESULTS: Assessment of MDI technique revealed that 35 percent of pati
ents used their MDI correctly on the first puff, and 42 percent used i
t correctly on the second puff. Following written instruction alone, c
orrect technique was demonstrated by 32 percent of patients with Diskh
aler and 6 percent with Turbuhaler. Technique significantly improved f
ollowing verbal instruction, although 40 percent of the patients requi
red up to three attempts to demonstrate correct technique on at least
one of the study.inhalers. After three days of clinical use, correct t
echnique was demonstrated in only 54 percent of the Diskhaler and 64 p
ercent of the Turbuhaler assessments. Performance at this assessment w
as, however, significantly better on the Turbuhaler than on the MDI (p
= 0.01). Performance on the Diskhaler was not significantly different
from the performance on the other inhalers. CONCLUSIONS: Written inst
ruction alone is inadequate in teaching correct inhalation technique.
Verbal instruction and technique assessment are essential for patients
to achieve proper technique. Patients may perform better on the Turbu
haler than on other inhalation devices.