title: Metered-dose inhalers: do emergency health care providers know what to teach?
abstract: OBJECTIVE
  To evaluate the ability of emergency health care providers and patients to demonstrate the proper use of metered-dose inhalers (MDIs).
  
  
  METHODS
  Prospective cross-sectional survey.
  
  
  METHODS
  Five Midwestern community teaching hospitals.
  
  
  METHODS
  One hundred eighty-five health care providers, comprising emergency medicine house staff (n = 60), attending emergency physicians (n = 50), and ED nurses (n = 75). Also recruited were 100 consecutive ED patients with clinical history of asthma being treated with at least one MDI for more than 3 months.
  
  
  METHODS
  We surveyed patients and health care providers to assess their knowledge of and ability to use a conventional MDI. The subject's technique of using a placebo inhaler was graded by a trained observer using a checklist of six essential steps.
  
  
  RESULTS
  Forty-one percent (76 of 185) of health care providers and 49% (49 of 100) of ED asthma patients performed at least five steps correctly (P = .24). There were no significant differences in performance scores among the emergency medicine house staff (42%), attending emergency physicians (34%), and ED nurses (45%). Only 15% of all health care providers and 17% of asthma patients were able to describe how to estimate the amount of medicine left in the canister.
  
  
  CONCLUSIONS
  These results suggest that many patients use MDIs improperly. Emergency physicians, house staff, and nurses responsible for instructing patients in optimal inhaler use may lack even rudimentary skills with these devices.
authors.affiliation: Department of Emergency Medicine, Butterworth Hospital, Grand Rapids, Michigan, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Jones
authors.forename: C P
authors.initials: CP
authors.lastname: Holstege
authors.forename: R
authors.initials: R
authors.lastname: Riekse
authors.forename: L
authors.initials: L
authors.lastname: White
authors.forename: T
authors.initials: T
authors.lastname: Bergquist
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005652:Functional Residual Capacity; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D009741:Nursing Staff, Hospital / Q000193:education*; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method