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Opportunistic optimization of inhaler technique in hospitalized adults with asthma: A two-phase educational study.

Koushan KouranlooMrinalini DeyJoseph HannaAnanya SinghAlice RaffertyStephen Scott
Published in: The Journal of asthma : official journal of the Association for the Care of Asthma (2023)
ObjectiveTo investigate effectiveness of two different educational methods to improve inhaler techniques in patients with prior diagnosis of asthma, hospitalized with a non-asthma-related diagnosis.MethodsWe undertook a real-world, opportunistic quality-improvement project. Inhaler technique in hospitalized patients with prior diagnosis of asthma was assessed in two cohorts over two 12-week cycles using a standardized device-specific proforma of seven-step inhaler technique, classed: "good" if 6/7 steps achieved; "fair" if 5/7 compliant; "poor" for others. Baseline data was collected in both cycles. Cycle one involved face-to-face education by a healthcare professional; cycle two involved additional use of an electronic device to show device-specific videos (asthma.org.uk). In both cycles, patients were reassessed within two days for improvements and the two methods compared for effectiveness.ResultsDuring cycle one 32/40 patients were reassessed within 48hours; eight lost to follow-up. During cycle two 38/40 patients were reassessed within 48hours; two lost to follow-upDuring cycle one, two and 12 had good/fair baseline technique respectively, and 26 poor. Most commonly missed steps were no expiry check/not rinsing mouth after steroid use. On reassessment 17% patients improved from poor to fair/good.During cycle two, initial technique assessment identified: 23 poor; 12 fair; five good. Post-videos, 35% of patients improved from poor to fair/good.Proportion of patients improving from poor to fair, or poor/fair to good increased in cycle two vs one (52.5% vs 33%).ConclusionVisual instruction is associated with improved technique compared to verbal feedback. This is a user-friendly and cost-effective approach to patient education.
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