title: Inappropriate techniques used by internal medicine residents with three kinds of inhalers (a metered dose inhaler, Diskus, and Turbuhaler): changes after a single teaching session.
abstract: BACKGROUND
  While initial education and regular evaluation of inhaler technique in patients are emphasized in the management of asthma and chronic obstructive pulmonary disease, health care professionals are not experienced in using inhalers. This study assessed whether internal medicine residents used common inhalers correctly and whether a single teaching session successfully improved their performance.
  
  
  METHODS
  We evaluated 142 internal medicine residents from six university hospitals in Korea for their techniques with three different inhaler devices: a metered dose inhaler (MDI), Diskus, and Turbuhaler. We assessed whether participants completed each step in using the three inhalers and classified overall performance as good, adequate, or inadequate for each inhaler type. To estimate the effect of a single teaching session, reassessment was performed 2 months after education.
  
  
  RESULTS
  Performance grade was inadequate for 50.7% of participants with a MDI, 43.0% for Diskus, and 51.4% for Turbuhaler. An early year of residency was associated significantly with inappropriate technique for Diskus (p = 0.003), but not for MDI and Turbuhaler. After a single teaching session, overall skills improved significantly for all three inhalers. The proportion of subjects with good or adequate skill changed notably from 39.7% to 83.8% for MDI (p = 0.001), from 50.0% to 86.8% for Diskus (p = 0.001), and from 44.1% to 88.2% for Turbuhaler (p = 0.001).
  
  
  CONCLUSIONS
  These findings demonstrate that a high proportion of internal medicine residents cannot use inhalers correctly and just a single teaching can effectively enhance their inhaler technique.
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Kim
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kwak
authors.forename: Tae-Bum
authors.initials: TB
authors.lastname: Kim
authors.forename: Yoon-Seok
authors.initials: YS
authors.lastname: Chang
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Jeong
authors.forename: Cheol-Woo
authors.initials: CW
authors.lastname: Kim
authors.forename: Ho Joo
authors.initials: HJ
authors.lastname: Yoon
authors.forename: Young Koo
authors.initials: YK
authors.lastname: Jee
mesh_terms: D000328:Adult; D000367:Age Factors; D002983:Clinical Competence / Q000706:statistics & numerical data; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007723:Korea; D008297:Male; D036501:Metered Dose Inhalers; D009330:Nebulizers and Vaporizers; D012737:Sex Factors