SAN DIEGO — Knowledge of correct inhaler administration among hospital-based physicians is relatively poor, with pulmonologists faring no better than general medicine physicians, results from a small study in the United Kingdom showed.
The finding “highlights the need for us as doctors to be able to use the inhalers so we can identify groups of patients that may benefit from them,” Dr. Aldrin Adeni said in an interview during a poster session at the annual meeting of the American Thoracic Society.
“Some devices are better for patients than others. If we don't know how the devices work, then we may prescribe an inhaler that's suboptimal for a patient,” he cautioned.
Dr. Adeni and his associates at the Royal Liverpool Hospital, England, asked 42 physicians to demonstrate the correct use of commonly prescribed inhaler devices. A specialist nurse and respiratory consultant jointly assessed hospital physicians of various grades and specialties taking placebo therapy, using six different inhaler devices (the metered-dose inhaler [MDI], Easi-Breathe, Autohaler, Accuhaler, Turbohaler, and HandiHaler) and two spacer devices (the Aerochamber and the Volumatic). A structured assessment sheet was completed for each physician using each device.
All study participants saw acute general medical admissions, including patients with respiratory diseases. More than half of the participants (26) were general medicine physicians, while the rest (16) were respiratory specialists or consultants.
Dr. Adeni reported that there were no significant differences between respiratory and nonrespiratory physicians, or between senior and junior physicians in the correct use of each inhaler.
The number of physicians who knew when inhalers were empty was greatest for the MDI (60%), followed by the Accuhaler (57%), Easi-Breathe (33%), Autohaler (24%), and Turbohaler (12%).
The percentage of physicians who knew how to correctly prepare the MDI and the Accuhaler was relatively high (73% and 86%, respectively), but dropped off sharply for the Turbohaler (38%), Easi-Breathe (29%), Autohaler (26%), MDI plus Volumatic (24%), and Aerochamber (17%).
Errors that were commonly observed with all inhalers included failing to shake, double dosing, breath-holding time, and knowing when the device is empty.
“We believe our findings highlight the need for improved education of all physicians concerning inhaler devices commonly prescribed,” the researchers concluded in their poster.
Dr. Adeni had no relevant conflicts to disclose.