Teaching to inhale: better utilization of powder inhalators after counseling and instruction

OBJECTIVE: To study the effect of instruction of patients who used an dry powder device on the correct performance of the inhalation technique and whether the effect lasts. DESIGN: Prospective. METHOD: A number of patients who used at least one drug by the dry powder devices Diskhaler or Diskus/Accuhaler were asked to demonstrate their inhalation technique in the outpatient clinic, Department of Pulmonary Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. On a score list the receptionist recorded the correctness of every step of use of the device. Then information and instruction on the correct performance of the inhalation technique were supplied by the same receptionist until the patient mastered the inhalation technique. A simple instruction card was handed to the patient. At the next outpatient visit the effect of the instruction was measured by means of the same score list registered by the same or another receptionist. RESULTS: Data from 97 patients could be evaluated; 42 men and 55 women, with a mean age of 58 years (range: 16-84). The percentage of patients who performed all essential actions correctly increased from 12 to 62. Almost all actions were performed better at the second than at the first visit. Better inhaling technique was observed in the 53 patients who paid their second visit within 30 days as well as in the 44 who came later (mean: 96 days; range: 34-352). CONCLUSION: The performance of the inhalation technique with the Diskhaler and the Diskus/Accuhaler was poor. By means of instruction the inhalation technique improved. This improvement was also seen in the group checked after an average of 3 months.