Checklists for Powder Inhaler Technique: A Review and Recommendations

Abstract

Turbuhaler and Diskus are commonly used powder inhaler devices for patients with respiratory disease. Their effectiveness is limited in part by a patient's ability to use them correctly. This has led to numerous studies being conducted over the last decade to assess the correct use of these devices by patients and health care professionals. These studies have generally used device-specific checklists to assess technique, this being the most feasible and accessible method for assessment. However, divergence between the checklists and scoring systems for the same device in different studies makes direct comparison of results difficult and at times inappropriate. Little evidence is available to assess the relative importance of different criteria; however, brief patient training based on specific inhaler technique checklists leads to significant improvement in asthma outcomes. This paper reviews common checklists and scoring systems used for Turbuhaler and Diskus, discusses the problem of heterogeneity between different checklists, and finally recommends suitable checklists and scoring systems for these devices based on the literature and previous findings. Only when similar checklists are used across different research studies will accurate comparisons and meta-analysis be possible.

Inhaler Technique Training and Health-Care Professionals: Effective Long-Term Solution for a Current Problem

“…At baseline, HCPs performed better in demonstrating technique with MDIs than with the Diskus and Turbuhaler. This is not surprising, since MDIs were introduced into the Jordanian market about 5 decades ago (1970), compared with a single decade for the DPIs (2002 27 discussing the rationale and/or evidence for inclusion or exclusion of specific steps, and providing recommendations about standardized checklists; the 9-point checklists used for Diskus and Turbuhaler in the present study corresponded exactly to these recommendations. For MDIs, we used a published 8-point checklist from intervention studies by ourselves and others, 28,30 and added an item for removal of the inhaler cap to make a 9-point checklist for consistency, and also because this step is essential for delivery of any medication.…”

“…Device technique for all HCPs was scored by the same investigator, with reference to a 9-point published checklist for each (Table 1). 27,28 The researcher assigned one point for each correct step and zero points for incorrect/missed step(s), and added the points to give the participant's inhaler technique score; for each checklist, a score of 9 indicates optimal use. All HCPs were invited to attend an educational workshop on asthma management.…”

The Effect of Using Simulation for Training Pharmacy Students on Correct Device Technique

“…The Diskus (GlaxoSmithKline, Philadelphia, Pennsylvania) and Turbuhaler (AstraZeneca Pharmaceuticals, Wilmington, Delaware), similar to the Flexhaler, are the most commonly used DPIs. 5,6 Incorrect device technique with both pMDIs and DPIs is a common issue among asthmatic patients. 3,4,7 In Jordan, a majority of patients and pharmacists failed to demonstrate the correct use of these devices.…”

A Method to Calculate Adherence to Inhaled Therapy that Reflects the Changes in Clinical Features of Asthma

“…In this case the average use over time is meaningless unless data on the technique of use is also incorporated into the calculation of the adherence. Most electronic recording devices usually do not assess if the inhaler was taken correctly (5)(6)(7)(8)(9)(10)(11)(12). Hence, there is a need to develop a method to quantify adherence that accounts for variations in dosing schedules as well as inhaler user technique.…”