title: Validation of scores of use of inhalation devices: valoration of errors.
abstract: OBJECTIVE
  To validate two scores quantifying the ability of patients to use metered dose inhalers (MDIs) or dry powder inhalers (DPIs); to identify the most common errors made during their use; and to identify the patients in need of an educational program for the use of these devices.
  
  
  METHODS
  This study was conducted in three phases: validation of the reliability of the inhaler technique scores; validation of the contents of the two scores using a convenience sample; and testing for criterion validation and discriminant validation of these instruments in patients who met the inclusion criteria.
  
  
  RESULTS
  The convenience sample comprised 16 patients. Interobserver disagreement was found in 19% and 25% of the DPI and MDI scores, respectively. After expert analysis on the subject, the scores were modified and were applied in 72 patients. The most relevant difficulty encountered during the use of both types of devices was the maintenance of total lung capacity after a deep inhalation. The degree of correlation of the scores by observer was 0.97 (p < 0.0001). There was good interobserver agreement in the classification of patients as able/not able to use a DPI (50%/50% and 52%/58%; p < 0.01) and an MDI (49%/51% and 54%/46%; p < 0.05).
  
  
  CONCLUSIONS
  The validated scores allow the identification and correction of inhaler technique errors during consultations and, as a result, improvement in the management of inhalation devices.
authors.affiliation: Departamento de Fisiopatologia Experimental, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR.
authors.forename: Letícia
authors.initials: L
authors.lastname: Zambelli-Simões
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR.
authors.forename: Maria Cleusa
authors.initials: MC
authors.lastname: Martins
authors.affiliation: Programa de Pós-Graduação em Assuntos Regulatórios, São Paulo, BR.
authors.forename: Juliana Carneiro da Cunha
authors.initials: JC
authors.lastname: Possari
authors.affiliation: Centro de Atenção Psicossocial Pró-Saúde Mental II - Álcool e Drogas, São Paulo, BR.
authors.forename: Greice Borges
authors.initials: GB
authors.lastname: Carvalho
authors.affiliation: Escola de Enfermagem, Universidade Federal da Bahia, Salvador, BR.
authors.forename: Ana Carla Carvalho
authors.initials: AC
authors.lastname: Coelho
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR.
authors.forename: Sonia Lucena
authors.initials: SL
authors.lastname: Cipriano
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR.
authors.forename: Regina Maria de
authors.initials: RM
authors.lastname: Carvalho-Pinto
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cukier
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, BR.
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy; D058995:Dry Powder Inhalers; D005260:Female; D006801:Humans; D001239:Inhalation / Q000502:physiology; D008297:Male; D036501:Metered Dose Inhalers; D015588:Observer Variation; D010353:Patient Education as Topic / Q000592:standards / Q000639:trends; D063046:Patient Medication Knowledge / Q000592:standards*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014109:Total Lung Capacity