HEALTH PROFESSIONAL EDUCATION

Health Professional Education Regarding Inhaler Technique Improve Symptom Control in Asthma Patients

Health Professional Education Regarding Inhaler Technique Improve Symptom Control in Asthma Patients

Literature Review

Professional Education for Asthma Patients

One of the most important goals of patient management in chronic illnesses is to achieve long-term changes in patient behaviour, particularly those relating to self-care. This is particularly important in asthma, a chronic disease with a major burden of symptoms, health care utilization, lost productivity or schooling, and cost of medications on the individual and the community (Hanania, Wittman, Kesten and Chapman, 1994, 111-116). Unlike many other chronic diseases, the medications used for asthma management are not primarily taken by tablet or capsule but by inhalation, to optimize delivery to the target organ. Obtaining the full therapeutic effect requires not only good adherence (itself a challenge) but also correct use of the inhaler.

This involves a series of steps which need to be performed correctly to ensure adequate medication delivery and minimize side effects. Incorrect use of inhalers leads to poor asthma control, increased hospital visits and increased cost of treatment. It can also increase side effects due to increased medication deposition in the upper airway. In addition, incorrect inhaler technique can reinforce poor medication adherence, because of patient dissatisfaction with suboptimal response. Unfortunately, incorrect inhaler technique is remarkably common; this is estimated to translate into $US7-15.7 billion wasted in the US each year because of incorrect asthma inhaler use. As a result, international guidelines stress the importance of checking inhaler technique.

Dry powder inhalers such as the Turbuhaler and Diskus (Accuhaler) were originally introduced in order to avoid known problems of poor technique with pressurized metered dose inhalers. However, inhaler technique is also a problem with dry powder devices, with 23-54% of Turbuhaler users and 24-50% of Diskus users found to have incorrect technique. Education to improve inhaler technique should thus be an important component of patient education in asthma, regardless of the inhaler device.

Unfortunately, the health care professionals who might be expected to deliver such education as part of routine asthma management perform very little better than patients in their ability to use asthma inhaler devices. The rate of incorrect inhaler technique amongst health care professionals ranges from 31-85%, with problems being found at similar levels amongst doctors (Hanania, Wittman, Kesten and Chapman, 1994, 111-116).

A variety of methods can be used for educating patients about correct inhaler technique. Provision of the manufacturer's instruction sheet alone is ineffective, even for those who read the leaflet. Personal instruction by a pharmacist is more effective than written instruction, and inclusion of a physical demonstration leads to improved inhaler technique. It has been observed that inhaler technique education must be repeated regularly in order to maintain correct technique.

However, after such education, it cannot be assumed that patient behaviour will change. Brennan and colleagues (2005, pp.97-102) distinguished between “competence” and “contrivance” with inhalers; following education, patients with asthma may demonstrate correct use of their devices to the health care professional, but then choose to use ...