ASSESSMENT OF PATIENT ACCEPTANCE AND INHALATION TECHNIQUE OF A PRESSURIZED AEROSOL INHALER AND 2 BREATH-ACTUATED DEVICES

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.