Increasing participation in and improving outcomes from pressurised metered dose inhaler training

Mark Sanders

Background: There is a continued requirement for the effective use of inhaler devices, and the undeniable importance of training. Many patients remain unable to use their inhaler correctly owing to their inability to understand the instructions and/or a perverse ability to use their device in an incorrect manner, or as a result of misguided lay advice. Inhaler technique training, specifically pressurised metered dose inhaler (pMDI) technique training, remains a significant issue for the industry and for healthcare professionals. Methods: Two new training aids, the Trainhaler® and Flo-Tone® respectively simulate pMDI use and help the patient co-ordinate pMDI actuation with the inspiratory manoeuvre. Following instruction based solely on user comprehension of the product Patient Instruction Leaflets for placebo pMDI and these training devices, pMDI technique was assessed before training, during use-training with Trainhaler plus Flo-Tone, and after training. The ability to carry out five tasks—[1] breathe out all the way, [2] put the inhaler into the mouth, over teeth and seal the lips around the mouthpiece, [3] start to inhale gently, [4] press canister, and [5] continue inhaling for about 5 seconds—was scored 0 (poor), 1 (average), or 2 (good). Data were analysed using McNemar’s test. Results: Twenty-four subjects completed the assessments. Tasks 3, 4 and 5 demonstrated significant improvement (P<0.05) following training with Trainhaler plus Flo-Tone. The overall score (mean of the sums of all scores for each subject) before (7.2) and after training (8.5) improved significantly (P<0.01). Prior to training three subjects achieved a maximum score of 10, increasing to 11 subjects after training. Conclusions: These are preliminary findings, and there are goals to achieve beyond new training aids. Training per se and outcomes from that better training should be improved. We should investigate the benefits of formal record keeping, promote patient self-support, and explore regular versus intermittent use of training tools.

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