Daniel M. Keller, PhD

May 28, 2013

PHILADELPHIA, Pennsylvania — A simple handheld training device doubles the likelihood that patients with asthma will achieve the correct inspiratory flow when using their medication inhalers.

After patients used the device, technique and flow rate were more likely to be in the acceptable range," said Catherine Vitari, BSN, RN, a certified asthma educator at the University of Pittsburgh School of Medicine, in Pennsylvania. "The more inhalers you have, the more the device helped, not only with the correct inspiratory flow," but also with the correct steps and technique, she told Medscape Medical News.

Vitari presented the results during a poster presentation here at the American Thoracic Society 2013 International Conference.

Correct technique and flow rate are essential for the optimal deposition of medication in patients' lungs. The device, called the In-Check Dial, not only measures flow rate, it also mimics the correct resistance for various inhalers. It can measure flows of 15 to 120 L/min.

The researchers randomized patients to teaching with the usual inhaler demonstrator models (control group; n = 19) or to teaching with the usual models plus the In-Check device (n = 21).

Four weeks later, they tested all patients for inspiratory flow with the device.

The study involved 7 different inhalers, although 2 inhalers were used by the majority of participants (73.7% in the control group and 47.6% in the In-Check group).

 
It will be a huge asset for our field.
 

At the 4-week visit, participants in the In-Check group were more likely than those in the control group to know the correct steps for inhaler use and to have inspiratory flow within the optimal range (P = .0429).

Participants in the In-Check group were also able to perform the steps better for closed-mouth metered-dose inhalers (P = .01) and for 3 different inhaler types (P = .0476).

Even after adjustment for the number of inhalers used, the odds of using the correct technique were better in the In-Check group than in the control group, and the marginal odds of having the correct inspiratory flow were tripled.

Vitari said it usually takes about 5 minutes to teach a person to use the In-Check device, and the proportion of patients within the correct flow range increased from 36% to 67% with the training. Further research will be needed to determine if the training effect is durable or extinguishes over time.

If this study is replicated and validated, "it will be a huge asset for our field," said Kristen Kloepfer, MD, assistant professor of medicine at Indiana University School of Medicine, in Indianapolis, who was asked by Medscape Medical News to comment on the study.

She explained that one of the barriers to asthma care is that many patients do not understand how to use their inhalers correctly. "It is a problem I see on a daily basis, and I believe this will be a great addition to care," she noted. "Every inhaler is different," she added. If a patient has used an inhaler in the past, the technique for a new inhaler might not be the same.

Training a patient with the In-Check device takes about 5 extra minutes. If asthma scores and quality of life improve, "the extra 5 minutes will be worth it in the long run," Dr. Kloepfer said. One less exacerbation "would save a lot of money," she added.

This study was funded by Healthy Lungs Pennsylvania, a nonprofit educator for lung diseases. Ms. Vitari and Dr. Kloepfer have disclosed no relevant financial relationships.

American Thoracic Society (ATS) 2013 International Conference: Poster A31. Presented May 19, 2013.

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