This is the first report assessing an education program's impact on teaching patients the psychomotor skills needed for proper use of the metaproterenol inhaler. Most patients do not use pressurized inhalers correctly. This inability could lead to suboptimal or ineffective therapy. Pharmacists provided a standardized education program to asthma patients and to those with chronic obstructive pulmonary disease for three clinic visits. Proper use of the inhaler was assessed by evaluating the patient's psychomotor performance for each visit before and after instruction. Of 19 patients, 18 demonstrated a mean improvement of 33.5 percent from preinstruction to postinstruction evaluation at the first visit (Student's t-test, p less than 0.0005). Both preinstruction and postinstruction scores demonstrated an upward trend for all three visits, the postinstruction scores always being higher than the preinstruction scores. These results indicate that our standardized education program helped improve psychomotor performance. Certain instructional aspects that need emphasis in future education programs have been identified.

In order to reduce the significant morbidity and mortality associated with asthma, current guidelines recommend the use of anti-inflammatory therapy in a step-wise approach. To obtain information on how physicians are treating asthma, we evaluated prospectively 243 newly seen asthmatics in the outpatient clinics in four hospitals in Riyadh. The patients were assessed by five pulmonologists who confirmed the diagnosis, established the severity, recorded the medications patients were taking, and the specialty of the prescribing physician. The inhaler technique was checked and changes made in the treatment were also recorded. The medications prescribed were 6 agonists (inhaled 69%, oral 25%), steroids (inhaled 33%, systemic 8%), cough mixtures (30%), antibiotics (26%), theophylline (21%), and miscellaneous 16%. Over half of the patients (55%) were taking 6 agonists regularly. The most frequent changes made were as follows: adding steroids (inhaled 56%, systemic 27%, or increasing the inhaled dose 16%), starting inhaled 6 agonists (28%) and discontinuing theophylline (9%). The GPs were the group least inclined to prescribe inhaled steroids (P < 0.0001). The inhaler technique was poor in 53% of the patients. We conclude that in treating asthma, physicians are still relying more on bronchodilator and symptomatic therapy rather than anti-inflammatory therapy. There is also evidence to suggest overuse of antibiotics. Wide dissemination of the guidelines may alter the prescribing habits, and as many asthmatics are managed by GPs, this group in particular should be targeted.