title: Evaluation of proficiency in using different inhaler devices among intern doctors.
abstract: BACKGROUND
  Doctors may have deficiencies in the ability to use different inhalers, which in turn, can result in improper technique by the patients and poorly controlled asthma and chronic obstructive pulmonary disease (COPD).
  
  
  OBJECTIVE
  To evaluate intern doctors' proficiency in using various inhaler devices.
  
  
  METHODS
  Seventy interns were evaluated for their proficiency in using pressurized metered dose inhaler (pMDI), pMDI with spacer, rotahaler, turbuhaler, and nebulizer. A structured assessment sheet was scored for identification and preparation of device, administration, coordination, and skill of explanation on a scale of 0-5. Common errors such as failure to shake pMDI before use, inability to identify the empty device, inadequate breath holding, and failure to advise gargles after use were recorded.
  
  
  RESULTS
  pMDI and pMDI with spacer were identified correctly by 89% and 79% of interns. Over 90% could identify rotahaler and nebulizer whereas only 9% could identify turbuhaler. 79% and 60% could prepare pMDI and pMDI with spacer appropriately. Nebulizer preparation was performed correctly by 79% and almost all interns could not prepare turbuhaler. Only one intern administered turbuhaler correctly. About half of the participants knew the correct co-ordination for pMDI and pMDI with spacer. Two interns showed proper co-ordination in using turbuhaler. None could provide correct explanation for turbuhaler usage; whereas 76% and 70% did it for nebulizer and rotahaler, respectively. Only 43% of interns remembered to shake pMDI before use.
  
  
  CONCLUSIONS
  Proficiency in using different inhaler devices amongst interns is poor. It is essential to provide adequate training for inhaler devices usage to medical graduates for proper management of asthma and COPD patients by those future primary care physicians and specialists.
authors.affiliation: Department of Respiratory Medicine, Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: Ravish M
authors.initials: RM
authors.lastname: Kshatriya
authors.affiliation: Department of Respiratory Medicine, Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: Nimit V
authors.initials: NV
authors.lastname: Khara
authors.affiliation: Department of Respiratory Medicine, Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: Rajiv P
authors.initials: RP
authors.lastname: Paliwal
authors.affiliation: Department of Respiratory Medicine, Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: Satish N
authors.initials: SN
authors.lastname: Patel
keywords: Improper tecnique; inhaler devices; interns; proficiency