Evaluation of Pediatric Residents’ Knowledge Levels on Inhaler Techniques Used in Asthma Treatment and the Effect of Education on the Level of Knowledge

Yıl 2022, Cilt: 16 Sayı: 5, 425 - 431, 20.09.2022

Zeynep Sengul Emeksiz , Ali Kansu Tehçi , Metin Yiğit , Başak Alan Tehçi , Emine Dibek Mısırlıoğlu

https://doi.org/10.12956/tchd.1125485

Öz

Objective: The use of inhaler drugs results in clinical success only when they are applied using the right technique. Faulty inhaler application techniques reduce therapeutic efficacy, impair treatment compliance, and lead to inadequate control of the disease. This study aimed to evaluate the knowledge levels of pediatric residents who play an important role in the follow-up of patients with pediatric asthma in both inpatient and outpatient services in a tertiary children’s hospital and to determine the effect of short-term training on the level of knowledge.

Material and Methods: All participants were asked to demonstrate the use of inhaler devices using demo devices. This assessment was designated as the “Pre-test.” The participants were then given face-to-face inhaler device training in groups of up to 15 people, which included all application steps. At the end of the training, the steps of inhaler device use were reassessed.

Results: Pre-training evaluation of inhaler technique on Metered Dose Inhaler and Dry Powder Inhaler devices showed that none of the 148 participants successfully completed the predetermined mandatory steps of the inhaler technique. After the training, it was observed that all participants were able to fully apply the steps of the previously determined checklist.

Conclusion: Medical school curricula and specialty education should include the application training of inhaler devices, which are extremely important for asthma treatment. Regular repetition of in-service training involving inhaler technique and application among health professionals can correct application errors and increase awareness regarding the importance of the right inhaler technique in the treatment of asthma.
Key Words: Asthma, Children, Inhaler, Treatment tech

Anahtar Kelimeler

Asthma, children, Inhaler, Treatment techniques

Pediatri Asistanlarının Astım Tedavisinde Kullanılan İnhaler Tedavi Teknikleri Konusunda Bilgi Düzeylerinin Değerlendirilmesi

Öz

Amaç: İnhaler ilaçların tedavi başarısı ancak doğru bir teknikle uygulanırsa mümkün olmaktadır. Hatalı inhaler teknik; terapötik etkinliği azaltır, tedavi uyumunu bozar ve hastalığın yetersiz kontrolüne yol açar. Çalışmamızda; üçüncü basamak çocuk hastanesinde hem yataklı servis hem de poliklinik hizmetlerinde astımlı çocuk hasta takibinde önemli rol üstlenen pediatri asistan hekimlerinin uygun inhaler teknik konusundaki bilgi düzeylerini değerlendirmek ve kısa süreli bir eğitimin bilgi düzeyine katkısını belirlemek amaçlanmıştır.

Gereç ve Yöntemler: Tüm katılımcılardan demo cihazlar ve manken kullanarak, inhaler cihaz kullanımını göstermeleri istendi. Bu değerlendirme ‘Ön-Test’ olarak adlandırıldı. Daha sonra katılımcılara maksimum 15 kişiden oluşan gruplar halinde, tüm uygulama basamaklarını içeren yüz yüze inhaler cihaz kullanım eğitimi verildi. Eğitim sonunda inhaler cihaz kullanımına ait basamaklar tekrar değerlendirildi.

Bulgular: Ölçülü Doz İnhaler ve Kuru Toz İnhaler cihazlara ait inhaler teknik ile ilgili eğitim öncesi değerlendirme sonucunda 148 katılımcıdan hiçbirinin önceden belirlenmiş zorunlu basamakları eksiksiz tamamlayamadığı görüldü. Eğitim sonrasında tüm katılımcıların önceden belirlenen kontrol listesinin adımlarını tam olarak uygulayabildikleri gözlemlendi.

Sonuç: Tıp fakültesi müfredatı ve uzmanlık eğitim sürecine astım tedavisi için son derece önemli olan inhaler cihazların uygulama eğitiminin dahil edilmesi gerektiğine dikkat çekmek istiyoruz. Sağlık profesyonelleri arasında, inhaler teknik uygulamalarını içeren hizmet içi eğitimlerin düzenli aralıklarla tekrarlanması uygulamadaki hataları gidermekle birlikte astım tedavisinde doğru inhaler tekniğin önemi konusundaki farkındalığı da arttıracaktır.

Anahtar Kelimeler

Astım, Çocuk, İnhaler, Tedavi Teknikleri

Kaynakça

• 1- Normansell R, Kew KM, Mathioudakis AG. Interventions to improve inhaler technique for people with asthma. Cochrane Database Syst Rev. 2017;3:CD012286.
• 2- Gleeson PK, Perez L, Localio AR, Morales KH, Han X, Bryant-Stephens T, Apter AJ. Inhaler Technique in Low-Income, Inner-City Adults with Uncontrolled Asthma. J Allergy Clin Immunol Pract. 2019;7:2683-2688.
• 3- Reznik M, Silver EJ, Cao Y. Evaluation of MDI-spacer utilization and technique in caregivers of urban minority children with persistent asthma. J Asthma. 2014;51:149-54.
• 4- Baddar S, Jayakrishnan B, Al-Rawas OA. Asthma control: importance of compliance and inhaler technique assessments. J Asthma 2014;51:429-34.
• 5- Klijn SL, Hiligsmann M, Evers SMAA, Román-Rodríguez M, van der Molen T, van Boven JFM. Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: a systematic review. NPJ Prim Care Respir Med. 2017;27:24.
• 6- Litt HK, Press VG, Hull A, Siros M, Luna V, Volerman A. Association between inhaler technique and confidence among hospitalized children with asthma. Respir Med. 2020;174:106191.
• 7- Minai BA, Martin JE, Cohn RC. Results of a physician and respiratory therapist collaborative effort to improve long-term metered-dose inhaler technique in a pediatric asthma clinic. Respir Care 2004;49:600-5.
• 8- Walia M, Paul L, Satyavani A, Lodha R, Kalaivani M, Kabra SK. Assessment of inhalation technique and determinants of incorrect performance among children with asthma. Pediatr Pulmonol 2006;41:1082-7.
• 9- Almomani BA, Al-Qawasmeh BS, Al-Shatnawi SF, Awad S, Alzoubi SA. Predictors of proper inhaler technique and asthma control in pediatric patients with asthma. Pediatr Pulmonol. 2021;56:866-874.
• 10- Sleath B, Ayala GX, Gillette C, Williams D, Davis S, Tudor G, Yeatts K, Washington D. Provider demonstration and assessment of child device technique during pediatric asthma visits. Pediatrics. 2011;127:642-8.
• 11- Sleath B, Carpenter DM, Ayala GX, Williams D, Davis S, Tudor G, Yeatts K, Gillette C. Communication during pediatric asthma visits and child asthma medication device technique 1 month later. J Asthma. 2012;49:918-25.
• 12- Laube BL, Janssens HM, de Jongh FH, Devadason SG, Dhand R, Diot P, Everard ML, Horvath I, Navalesi P, Voshaar T, Chrystyn H; European Respiratory Society; International Society for Aerosols in Medicine. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37:1308-31.
• 13- Can C, Akkelle E, Gökmirza Özdemir P, Yazıcıoğlu M, Süt N. Assessment of regular drug use and inhaler technique skills in asthmatic children. Allergol Immunopathol (Madr). 2020;48:124-129.
• 14- Deerojanawong J, na Sakolnakorn VP, Prapphal N, Hanrutakorn C, Sritippayawan S. Evaluation of metered-dose inhaler administration technique among asthmatic children and their caregivers in Thailand.Asian Pac J Allergy Immunol 2009;27:87-93.
• 15- Reznik M, Silver EJ, Cao Y. Evaluation of MDI-spacer utilization and technique in caregivers of urban minority children with persistent asthma. J Asthma. 2014;51:149-54.
• 16- Owayed A, Al-Ateeqi W, Behbehani N. Proficiency of pediatricians in the use of inhaled medication delivery systems for the management of asthma. J Asthma. 2006;43:459-62.
• 17- Iheagwara K, Sharif I, Ozuah PO. Do pediatric healthcare providers know how to use metered dose inhaler plus spacer devices? Prim Care Respir J 2005;14:172-3.
• 18- Resnick DJ, Gold RL, Lee-Wong M, Feldman BR, Ramakrishnan R, Davis WJ. Physicians' metered dose inhaler technique after a single teaching session. Ann Allergy Asthma Immunol 1996;76:145-8.
• 19- Spaggiari S, Gehri M, Di Benedetto L, Hafen GM, Pauchard JY, Gervaix A, Pannatier A, Sadeghipour F, Paolo ERD. Inhalation technique practical skills and knowledge among physicians and nurses in two pediatric emergency settings. J Asthma 2021;58:190-196.
• 20- Capanoglu M, Misirlioglu ED, Toyran M, Civelek E, Kocabas CN. Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children with asthma using metered dose or dry powder inhalers. J Asthma 2015;52:838-45. 21- Shaw N, Le Souëf P, Turkovic L, McCahon L, Kicic A, Sly PD, Devadason S, Schultz A. Pressurised metered dose inhaler-spacer technique in young children improves with video instruction. Eur J Pediatr. 2016;175:1007-12.
• 22- Bosnic-Anticevich SZ, Sinha H, So S, Reddel HK. Metered-dose inhaler technique: the effect of two educational interventions delivered in community pharmacy over time. J Asthma. 2010;47:251-6.
• 23- Self TH, Arnold LB, Czosnowski LM, Swanson JM, Swanson H. Inadequate skill of healthcare professionals in using asthma inhalation devices. J Asthma. 2007;44(:593-8.
• 24- Kellman DA, Iserson KV, Levy RD, McIntosh B, Maxwell Y. Brief Education Improves Proper Metered-Dose Inhaler Use. J Emerg Med. 2020;58:667-672.
• 25- Plaza V, Sanchis J, Roura P, Molina J, Calle M, Quirce S, Viejo JL, Caballero F, Murio C. Physicians' knowledge of inhaler devices and inhalation techniques remains poor in Spain. J Aerosol Med Pulm Drug Deliv. 2012;25:16-22.
• 26- Payares-Salamanca L, Contreras-Arrieta S, Florez-García V, Barrios-Sanjuanelo A, Stand-Niño I, Rodriguez-Martinez CE. Metered-dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta-analysis. Pediatr Pulmonol. 2020;55:3268-3278.
• 27- https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf
• 28- Gillette C, Rockich-Winston N, Kuhn JA, Flesher S, Shepherd M. Inhaler Technique in Children With Asthma: A Systematic Review. Acad Pediatr. Sep-2016;16:605-15.
• 29- Plaza V, Giner J, Rodrigo GJ, Dolovich MB, Sanchis J. Errors in the Use of Inhalers by Health Care Professionals: A Systematic Review. J Allergy Clin Immunol Pract. 2018;6:987-995.