A prospective observational study of patient training in use of the autohaler inhaler device: the Sirocco study.

BACKGROUND: Asthma guidelines recommend that patients receive inhaler technique training, with rechecks at each visit. However, suboptimal inhaler technique is common.
METHODS: This prospective observational study evaluated patient training in use of the Autohaler, a breath-actuated metered-dose inhaler. Physicians enrolled the first four consecutive, eligible adult patients receiving inhaled corticosteroid therapy for asthma. Patients demonstrated their inhaler technique after seeing a demonstration of proper technique and again after physicians gave verbal instruction addressing individual difficulties in technique. Their first and last attempts were evaluated using a 12-item checklist comprising 7 consecutive steps for correct inhaler use and 5 potential errors in device handling or inhalation manoeuvre.
RESULTS: A total of 1723 physicians (91% general practitioners) enrolled 6512 patients (mean age 43 years, 52% male). On their first attempt, 2561/6387 (40.1%) of patients were able to complete all procedural steps correctly and without error. A poor inhalation manoeuvre was the most common cause of failure in technique. After education, 91.4% of patients were able to complete all procedural steps correctly and without error. Training session median length was 4 minutes (range 0-45 minutes).
CONCLUSIONS: Practical training, coupled with demonstration of inhaler use and observation of technique by a physician, can help patients to improve their inhaler technique and appears feasible in every day practice. Further work is needed to evaluate whether patients maintain good inhaler technique and whether physicians continue the training sessions in everyday practice.