D H Johnson1, P Robart. 1. Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, MA 02114, USA. djohnson@helix.mgh.harvard.edu
Abstract
OBJECTIVE: Assess the role of evaluation, instruction, and use of spacers by patients using metered dose inhalers (MDIs) in the home. PATIENTS AND SETTING: Patients (age 64 +/- 15 y [mean +/- standard deviation]) receiving home visits by respiratory care practitioners for oxygen therapy had their inhaler technique checked. INTERVENTIONS AND MEASUREMENTS: A detailed acceptable/unacceptable check-off list was used with 172 patients to evaluate inhaler technique. Patients with poor technique were given instruction and their technique was reassessed. A subgroup of 43 patients was reevaluated on up to 3 visits. RESULTS: Only 18% of patients using MDIs without spacers were rated acceptable with the detailed check list. Instruction improved inhaler technique, but few patients with initially poor technique without spacers developed fully acceptable technique. Improvements made immediately following instruction were lost when patients were reevaluated months later. Few patients received spacers after they were recommended. Technique was markedly better with spacers. Most patients (76%) had initially proper technique with spacers, and most who had poor technique could learn and retain proper technique. CONCLUSIONS: Improper inhaler technique without spacers is very common among patients evaluated at home, and the majority of patients were unable to learn and retain proper technique. Most patients would benefit from using spacers with their inhalers. = 33 for first and second. = 26 for third. FRC = functional residual capacity. RV = residual volume. TLC = total lung capacity.¿., Fig. 3¿/PICK;0404f3;;;page;;;;yes;1¿ ¿/GRAPH;rk1000404003;comptd;;center;stack¿ ¿/CAPT;;;center;stack;2112n¿
OBJECTIVE: Assess the role of evaluation, instruction, and use of spacers by patients using metered dose inhalers (MDIs) in the home. PATIENTS AND SETTING:Patients (age 64 +/- 15 y [mean +/- standard deviation]) receiving home visits by respiratory care practitioners for oxygen therapy had their inhaler technique checked. INTERVENTIONS AND MEASUREMENTS: A detailed acceptable/unacceptable check-off list was used with 172 patients to evaluate inhaler technique. Patients with poor technique were given instruction and their technique was reassessed. A subgroup of 43 patients was reevaluated on up to 3 visits. RESULTS: Only 18% of patients using MDIs without spacers were rated acceptable with the detailed check list. Instruction improved inhaler technique, but few patients with initially poor technique without spacers developed fully acceptable technique. Improvements made immediately following instruction were lost when patients were reevaluated months later. Few patients received spacers after they were recommended. Technique was markedly better with spacers. Most patients (76%) had initially proper technique with spacers, and most who had poor technique could learn and retain proper technique. CONCLUSIONS: Improper inhaler technique without spacers is very common among patients evaluated at home, and the majority of patients were unable to learn and retain proper technique. Most patients would benefit from using spacers with their inhalers. = 33 for first and second. = 26 for third. FRC = functional residual capacity. RV = residual volume. TLC = total lung capacity.¿., Fig. 3¿/PICK;0404f3;;;page;;;;yes;1¿ ¿/GRAPH;rk1000404003;comptd;;center;stack¿ ¿/CAPT;;;center;stack;2112n¿