Physicians’ and pharmacists’ knowledge of inhaler technique in the Azores

Abstract

Objectives: To evaluate physicians’ and pharmacists’ knowledge and competence in the use of pressurized metered dosed inhalers and turbohalers. Study Design: Multicenter cross-sectional. Setting: Primary healthcare centers, pediatric and internal medicine services, and pharmacies on four Azorean islands. Participants: Family physicians, internists, pediatricians, and pharmacists. Methods: A census of the population of physicians and a convenience sample of pharmacists were obtained. Health care providers were asked to demonstrate the use of two inhaler devices. The authors observed each step using a checklist. Logistic regression was used for data analysis. Results: The study population included 45 pharmacists, 91 family doctors, 26 internists and 19 pediatricians. The mean age of participants 40.8 years (±12.2), and 66.9% (121) of the sample were women. Five participants (2.8%) correctly demonstrated inhalation technique with both devices. The most prevalent errors observed were failing to exhale to residual volume, failing to hold the inhaled breath for 5 seconds with both inhalation devices, failure to wash the mouth with water if the device contained steroids, and failure to shake the metered dosed inhaler before using it. Poor knowledge about inhalation technique with the metered dosed inhaler was related to being a pharmacist (OR=4.94), age between 61 and 65 years (OR=5.95), and explaining the technique to patients ‘sometimes, almost never, or never’ (OR=3.63). With the dry powder inhaler, poor knowledge about inhalation technique was related to being a pharmacist (OR=3.51), being an internist (OR=6.55), age between 36 and 50 years (OR=3.68), age between 51 and 65 years (OR=11.44), and practicing in Faial island (OR=15.98). Conclusions: This study showed that most health care providers fail in their explanation of some essential steps in the correct use of inhalation devices.