Does introduction of new "easy to use" inhalational devices improve medical personnel's knowledge of their proper use?

Ann Allergy Asthma Immunol. 2002 Apr;88(4):395-400. doi: 10.1016/S1081-1206(10)62371-X.


Background: Lack of basic inhaler skills by medical personnel has been documented by numerous studies. Consequently, training of patients in correct inhalational technique suffers. Newer dry powder inhalers such as Turbuhaler (budesonide, Astra USA, Westborough, MA) and Diskus (salmeterol, GlaxoSmithKline, Research Triangle Park, NC) have some advantages over conventional metereddose inhalers (MDIs) including easier technique of usage. They have been recently marketed with the hope of overcoming this problem.

Objective: To determine whether introduction of newer "easy to use" dry powder inhalers such as budesonide (Turbuhaler) and salmeterol (Diskus) would result in improvement in medical personnel's knowledge of their proper use.

Methods: In and around a community-based teaching hospital, interviews were conducted in March 2000 of 50 assorted randomly selected medical personnel. They included 10 respiratory therapists, 10 registered nurses, 10 medical residents, 10 primary care physicians, and 10 pharmacists. Objective evaluation was made of their skills demonstration and knowledge scores for usage of MDIs, budesonide, and salmeterol.

Results: Mean percentage demonstration scores of different medical personnel for all three devices taken together: respiratory therapist (81.6%), primary care physicians (77.7%), pharmacists (57.7%), registered nurses (54.4%), and medical residents (53.8%). Mean percentage demonstration scores of different inhalers for all medical personnel taken together: MDI (80.9%), salmeterol (64.2%), budesonide (49.9%). Mean percentage knowledge score of all three inhalational devices taken together for respiratory therapist was the best at 76.6%. Registered nurses performed the worst with a score of 52.0%. Mean percentage knowledge scores: MDI (78%), salmeterol (63.2%), and budesonide (52.4%). A repeated measures two-way analysis of variance demonstrated that differences in both demonstration and knowledge scores between inhaler types and between medical personnel were all highly statistically significant (P < 0.0001).

Conclusions: Demonstration skills and knowledge scores for use of both budedsonide and salmeterol were substantially lower than that for MDI for all medical personnel. Medical personnel responsible for teaching the correct use of inhalational devices are lacking in basic knowledge and user skills. This likely contributes to patient's poor technique when using these devices.

MeSH terms

  • Adult
  • Albuterol / administration & dosage
  • Albuterol / analogs & derivatives*
  • Budesonide / administration & dosage
  • Equipment Design
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Personnel / psychology*
  • Hospitals, Teaching
  • Humans
  • Internship and Residency
  • Male
  • Middle Aged
  • Nebulizers and Vaporizers*
  • Nurses / psychology
  • Patient Education as Topic
  • Pharmacists / psychology
  • Physicians, Family / psychology
  • Professional Competence
  • Respiratory Therapy
  • Salmeterol Xinafoate
  • Surveys and Questionnaires


  • Budesonide
  • Salmeterol Xinafoate
  • Albuterol