title: Proficiency of pediatricians in the use of inhaled medication delivery systems for the management of asthma.
abstract: OBJECTIVE
  To evaluate the proficiency of pediatricians in the demonstration of the proper use of metered-dose inhalers (MDIs) and to assess their theoretical knowledge of inhalation devices used in the management of asthma.
  
  
  METHODS
  Prospective cross-sectional survey.
  
  
  METHODS
  Two university-affiliated hospitals.
  
  
  METHODS
  Seventy-one pediatricians and pediatric house staff.
  
  
  METHODS
  Each pediatrician's technique was graded by two trained observers using a checklist of six essential steps recommended by national guidelines. Theoretical knowledge of asthma devices was evaluated by a written questionnaire.
  
  
  RESULTS
  Twenty (35.2%) pediatricians performed at least five steps correctly, 28 (39.4%) performed three or four steps correctly, and 18 (25.4%) performed two steps or less correctly. The most common errors were failure to start inhalation from functional residual capacity, failure to inhale slowly, and failure to wait at least 20 seconds before the next puff. Senior pediatricians were more skillful in the practical use of MDIs than were pediatric house staff (p = 0.03). The most common deficiencies in theoretical knowledge were related to estimation of the amount of medication in the canister (8.5% correct) and how valved holding chambers (VHCs) improve drug delivery to the lung (15.5% correct).
  
  
  CONCLUSIONS
  Pediatricians in Kuwait have significant deficiencies regarding the practical and theoretical aspects of MDIs and other inhalation devices.
authors.affiliation: Department of Pediatrics, Kuwait University, Kuwait. owayedaf@hsc.edu.kw
authors.forename: A
authors.initials: A
authors.lastname: Owayed
authors.forename: W
authors.initials: W
authors.lastname: Al-Ateeqi
authors.forename: N
authors.initials: N
authors.lastname: Behbehani
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics; D010818:Practice Patterns, Physicians'
chemical_list: D018927:Anti-Asthmatic Agents