title: Patient handling of a dry-powder inhaler in clinical practice.
abstract: BACKGROUND
  Multi-dose dry-powder inhalers are perceived as being easier for patients to use than conventional pressurized aerosol inhalers; however, no study has determined whether patients handle such devices adequately and whether there is a need for patient education in this area.
  
  
  METHODS
  We used trained observers to assess the handling of a specific multi-dose dry powder inhaler (Turbuhaler; AstraZeneca Canada; Mississauga, ON) by patients currently using the device for the management of their asthma. Fourteen discrete steps were scored independently by two observers simultaneously. Patients were divided into two groups for analysis: those who had received formal instruction in the use of the inhaler at The Asthma Centre and those who had received no formal instruction in the community.
  
  
  RESULTS
  There was no significant difference between the formally trained groups and control groups in the percentage of handling steps performed correctly (79% vs 78%, respectively; p > 0.05). Fewer than 50% of patients in both groups demonstrated optimal breath-holding when using the device.
  
  
  CONCLUSIONS
  Patient handling of Turbuhaler was generally good, with no evidence that a structured education intervention offered an advantage over the usual education incidental to the prescribing or dispensing process. The most common handling flaw, suboptimal breath-holding, is not specific to this device and is of uncertain clinical significance.
authors.affiliation: Asthma Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Epstein
authors.forename: A
authors.initials: A
authors.lastname: Maidenberg
authors.forename: D
authors.initials: D
authors.lastname: Hallett
authors.forename: K
authors.initials: K
authors.lastname: Khan
authors.forename: K R
authors.initials: KR
authors.lastname: Chapman
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D015588:Observer Variation; D010353:Patient Education as Topic; D011208:Powders; D012646:Self Administration
chemical_list: D018927:Anti-Asthmatic Agents; D011208:Powders