Demonstrating and Assessing Metered-Dose Inhaler–Spacer Technique

Abstract

The National Asthma Education and Prevention Program recommends that providers demonstrate and assess metered-dose inhaler-spacer (MDI-S) technique at each medical visit. To examine practice behaviors and perceived barriers to demonstrating and assessing MDI-S technique, we surveyed pediatric providers (n = 114) at an inner-city academic medical center. While 82% of providers demonstrated MDI-S technique, only 5% of providers demonstrate the technique at every visit. Although 67% of providers assessed MDI-S technique, only 13% assess the technique at every visit. None of the providers used MDI-S checklist for assessment. Attendings were more likely than residents to demonstrate with illustrations (24% vs 6%, P = .01) and when patient's asthma was not well controlled (68% vs 47%, P = .05). Provider-identified barriers included limited access to MDI-S device, lack of time, and inadequate knowledge. Suggestions to address barriers include in-service training, device access, and nurse/health educators to alleviate the time constraints. Clinic modifications and education are needed.

Aerosol Therapy in Asthma–Why We Are Failing Our Patients and How We Can Do Better

“…Most asthma management guidelines (1, 2) strongly recommend that inhaler technique should be assessed at every opportunity however there is evidence that this is often not done (17). Suggested barriers to checking/correcting inhaler technique include insufficient clinic time, limited clinician training and knowledge on inhalers and lack of demonstration supplies (18). In addition, health care professionals may ask children/parents about their ability to use their inhaler and use the reply confidence as a proxy to determine whether education is needed.…”