title: User error with Diskus and Turbuhaler by asthma patients and pharmacists in Jordan and Australia.
abstract: BACKGROUND
  Use of inhalers requires accurate completion of multiple steps to ensure effective medication delivery.
  
  
  OBJECTIVE
  To evaluate the most problematic steps in the use of Diskus and Turbuhaler for pharmacists and patients in Jordon and Australia.
  
  
  METHODS
  With standardized  inhaler-technique checklists, we asked community pharmacists to demonstrate the use of Diskus and Turbuhaler. We asked patients with asthma to demonstrate the inhaler (Diskus or Turbuhaler) they were currently using.
  
  
  RESULTS
  Forty-two community pharmacists in Jordan, and 31 in Australia,  participated. In Jordan, 51 asthma patients demonstrated use of Diskus, and 40 demonstrated use of Turbuhaler. In Australia, 53 asthma patients demonstrated use of Diskus, and 42 demonstrated use of Turbuhaler.
  
  
  RESULTS
  The pharmacists in Australia had received inhaler-technique education  more recently than those in Jordan (P = .03). With Diskus, few pharmacists in either country demonstrated correct technique for step 3 (exhale to residual volume) or step 4 (exhale away from the device), although there were somewhat fewer errors in Australia than Jordan (16% vs 0% in  step 3, P = .007, and 20% vs 0% in step 4, P = .003 via chi-square test). With Turbuhaler there were significant differences between the pharmacists from Australia and Jordan, mainly in step 2 (hold the device upright while loading, 45% vs 2% correct, P < .001). Few  of the patients had received inhaler-technique education in the previous year. The patients made errors similar to those of the pharmacists in individual steps with Diskus and Turbuhaler. The essential steps with Diskus were performed correctly more often by the Jordanian patients, and with  Turbuhaler by the Australian patients.
  
  
  CONCLUSIONS
  Despite differences in Jordan's and Australia's health systems, pharmacists from both Australia and Jordan had difficulty with the same Diskus and Turbuhaler steps. In both countries, the errors made by the asthma patients were similar to  those made by the pharmacists.
authors.affiliation: Faculty of Pharmacy, Applied Science Private University, Amman, Jordan. ibasheti@usyd.edu.au
authors.forename: Iman A
authors.initials: IA
authors.lastname: Basheti
authors.forename: Eyad
authors.initials: E
authors.lastname: Qunaibi
authors.forename: Sinthia Z
authors.initials: SZ
authors.lastname: Bosnic-Anticevich
authors.forename: Carol L
authors.initials: CL
authors.lastname: Armour
authors.forename: Samar
authors.initials: S
authors.lastname: Khater
authors.forename: Muthana
authors.initials: M
authors.lastname: Omar
authors.forename: Helen K
authors.initials: HK
authors.lastname: Reddel
mesh_terms: D000328:Adult; D001249:Asthma / Q000628:therapy*; D001315:Australia; D003430:Cross-Sectional Studies; D004867:Equipment Design; D004868:Equipment Failure / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis; D006801:Humans; D007597:Jordan; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000592:standards / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000592:standards*