National asthma guidelines to improve asthma outcomes rely on inhaled medications. However, it has been commonly recorded that the majority of asthma patients use inhalers incorrectly and that poor inhaler technique is correlated with poor asthma control. In fact, more than 25% of the 25 billion dollars spend on inhalers annually are misspent on incorrect inhaler use. Common inhaler education is written instruction, but some patients receive no training. We decided to test the effectiveness of a computer based training solution versus traditional written instruction on inhaler technique. An example of a computer based training solution used was videos found at use-inhalers website. The computer based training would be easy to use and implement in clinics, or directly to patients at home. We hypothesize that it can increase a provider's ability to deliver high quality instruction to all patients without increasing time burden on providers. Our controls were patients without any training and patients given written training. Videotapes of patients using their inhalers before and after training were created and analyzed by a fixed rubric and given a score. 50 patients were recruited in the Junta De Beneficencia Hospital in a randomized, unblended enrollment process. Analysis was done through multivariate regression analysis where the different trainings were binomial indicator variables. Video training improved inhaler technique by more than 70% and did not show age preference. Written training had little to no influence on inhaler technique, and on average, only improved technique by less than 10%. We conclude that (1) written instruction may not be enough to instruct patients for inhaler technique education (in fact, most patients missed more than 50% of the necessary steps) and (2) a computer-based alternative can have the desired educational effect without an increased time effort.

Study Procedures

At hospital discharge, eligible subjects were approached to participate by doctors. In addition, members of the Asthma Club of Guayaquil were encouraged to come participate. Each patient conducted an interviewer-led ACT (Asthma Control Test). The test judges general asthma control; it asks questions dealing with shortness of breath, ER visits, inhaler use, and inhaler effectiveness. It is graded out of 25 points per patient. Phone numbers as well as age was collected.

 

Individuals participating in the study were video recorded using their inhaler from their current knowledge. A control group was given Spanish written training (the extent of normal training and re-filmed for technique improvement. The video based training is located at the website of use-inhalers. It incorporates simple videos of healthcare professionals using their inhalers, and uses the webcam to create a mirror for the patients who can practice their inhalers along with videos.

Study Design

A prospective, randomized, unblended enrolling of 50 patients at the Luis Vernaza Hospital in Guayaquil, Ecuador. Other patients will be recruited from other head position, proper grip, exhalation, and inhalation upon inhaler activation, release of medication, and holding their breath. They were graded on an 11 point rubric. They would receive up to points for doing each step correctly for up to 11 points. The steps and criteria for correct inhaler technique coincide used with international standards on inhaler use and common problems that are encountered for Metered Dose Inhalers.

Results

The study population consisted of 50 patients who took videos of themselves using their inhalers 2 times, giving us 100 videos to work with. Table 1 shows the base data that we obtained from our study – it shows the averages for age and ACT score (a representation of respiratory health) for each group, as well as on average, their inhaler technique before and after training. Our initial analysis shows that video training is positively correlated with improved inhaler technique, while written training does not seem to be correlated with improved training. It is not also important to note that age nor was act score very different between the two groups.